Name: New Approaches for Esthetic and Periodontal Surgery

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The concept of minimal intervention dentistry has become a primary approach to treat carious lesions. And these days this concept could be adapted to manage soft tissue around the teeth and implants as a Minimally Invasive Technique.

This Minimally Invasive Technique makes it possible to achieve satisfying esthetic results as well as biological success, especially by using high magnification loupes and microscopes.

Additionally, more and more patients desire these minimally invasive techniques instead of conventional techniques.

Case 1
The patient in the first case was a 45-year-old female, and her chief complaint was an esthetic disorder. Tooth #8 suffered from severe periodontal disease (Fig: Case1_01,02).

Her oral photo showed that apical tooth position, low papilla, thin scallop, and low crest, of tooth #8.

Based on these traits, I thought this case was difficult. So I went with a staged approach rather than an immediate implant placement.

First of all, limited orthodontic treatment (forced eruption) was performed to correct the gingival line (Fig: Case1_03). And after that, tooth #8 was extracted, and autogenous bone from the palate was gathered, and the socket was filled with bone, and closed with connective tissue (Fig: Case1_04).

After 6 months of healing, an implant was placed (Fig: Case1_05) and again allowed to heal. Then we did implant exposure with a connective tissue graft. The photo shows before abutment setting, and final restorations (Fig: Case1_06,07). At the 4-year check-up, soft tissue around the implant was still stable and very beautiful (Fig: Case1_08).

Case 2
The second case shows a traumatic soft and hard tissue wound on the maxillary anterior and its rehabilitation. The patient was a 22-year-old women, and her chief complaint was severe esthetic disorder because of her trauma.

She lost two incisor teeth as well as tissue and bone around the teeth (Fig: Case2_01).

Before placing the implant, the procedure would require a bone graft. I removed the right wisdom tooth on the mandibular, and took a bone block at the same time from the neighboring bone around the wisdom tooth (Fig: Case2_02).

After an 8-month healing period, the implants were placed and a second bone graft and the left wisdom tooth removal were done (Fig: Case2_03). Again after enough healing, the implant was exposed and a connective tissue graft around the implants was operated.

However, the papillae between two implants were still not good enough, so I went back to the surgery again with a papillae reconstruction technique (Fig: Case2_04). The photo shows the post-op with the ceramic restorations for the implants (Fig: Case2_05,6).

Conclusion
Based on these case reports I would like to enlighten dental practitioners in order to help them in the implementation of modern concepts into everyday surgical practice by showing my cases with Minimally Invasive Technique. I hope the application of the concept may offer a powerful option for esthetic dentists to provide less invasive treatment to their patients.

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