Dr.Prashanthy R

💫Tissues that frames your smile💕 whether the crown will last or fail depends largely on the underlying periodontal tissues around tooth.
☄️Periodontal flap procedure before Prosthesis without losing papilla and soft tissue .
Getting a Perio evaluation before esthetic procedures can prevent
☄️Swelling of gums after few months of crown / veneer delivery
☄️Exudation or patient feeling salty taste from gums
☄️Redness around gums showing red white esthetic’s instead of pink white
☄️Mobility of teeth with Crown after years due to periodontal disease progression.
☄️Opening up triangular spaces between tooth crowns and progressive food lodgement with pain .
Prosthodontic work by talented Dr. AbdulRahman .abdulrahmanalali .
Patient visited us with the complain of black triangles between teeth and wanted to change her smile , after careful clinical examination and radio graphic evaluation in this patient we prevented the possibility of progressive periodontal disease and periodontal gum treatment was immediately started to prevent further bone loss. 2 years follow up and beautiful healing . Patient happy and so are we .

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Picturesque gems in Swiss alps Saanen & Gstaad.
Interlaken when got famous truly because of our Yash Chopra ji movies , posing for a pic in front of Saanen bridge ( Palat palat bridge ) with Shahrukh nd Kajol thought it’s mandatory.
Serene beauty of Saanen s quaint streets , St Mauritius church Saanen , mesmerizing Mountain View’s, interlaken town nestled between the turquoise water of lake Thun and lake Breinz.
We boarded the Belle Epoque train from Zweissman Railway station ( Raj & Simran missed the train in movie DDLJ) to Montreax, for the breathtaking view of diverse scenery , pristine lakes , charming villages .
Top of the Europe , Jungfrauch is famous for its towering peaks like Eiger , Monch , Jungfrauch.
Glacier 3000 has the world’s first suspension bridge connecting two mountain peaks . Breathtaking views of Mont Blanc nd Matterhorn.
The best cable car ride in Switzerland to Jungfraoch passing through Grindelwald Swiss mountain village and many more Swiss delights .
Overall a refreshing Best air quality index place Switzerland , go and get healed .

𝐏𝐞𝐫𝐢𝐨𝐝𝐨𝐧𝐭𝐚𝐥 𝐭𝐨𝐮𝐜𝐡 𝐠𝐢𝐯𝐞𝐧
𝐚 𝐠𝐫𝐞𝐚𝐭 𝐬𝐦𝐢𝐥𝐞 𝐦𝐚𝐤𝐞𝐨𝐯𝐞𝐫 𝐟𝐨𝐫 𝐭𝐡𝐢𝐬 𝐩𝐚𝐭𝐢𝐞𝐧𝐭 𝐛𝐲 𝐃𝐫 .abdulrahmanalali + photography credits
𝐂𝐨𝐦𝐛𝐢𝐧𝐚𝐭𝐢𝐨𝐧 𝐨𝐟 𝐠𝐢𝐧𝐠𝐢𝐯𝐞𝐜𝐭𝐨𝐦𝐲 +𝐬𝐮𝐫𝐠𝐢𝐜𝐚𝐥 𝐜𝐫𝐨𝐰𝐧𝐥𝐞𝐧𝐠𝐭𝐡𝐞𝐧𝐢𝐧𝐠 ( routine clinical practice or everyday procedure )

When crown margin will impinge on the biological width BW, use of flap surgery with osseous reduction will preserve BW , with a minimum of 3mm Attached Gingiva .
Things to note while performing procedure to avoid
1. Sharp ridge or crater while thinning bone around teeth can create uneven soft tissue topography.
🌷Solution : use of proper tools , ensure smooth bone contour during osseous recontouring.
2. Poor esthetic’s resulting from enlarged gingival embrassures, root sensitivity transient mobility / root resorption 🌷Solution - creating secondary papilla + right suturing technique
3. Loss of inter proximal papilla , black triangle .
🌷Solution : preservation of inter proximal papilla during incision
💫💫Before suturing , ensure that the flaps are without tension and preferably covering where the eventual crown margin will be placed .

CBCT / 3D X-rays can better depict bony defects , craters and furcation involvement , however periodontal ligament (PDL) space better scored on periapical X-rays.

This saving tooth attempt as patient wanted and it’s a success 🙌… Only Perio treatment was performed so far though perio +endo was the treatment plan . Patient has no sensitivity or pain after thd procedure .
In this case as clinical baseline examination showed a good attached gingiva and soft tissue coverage on tooth both labial and palatal side, never assumed the defect to be this large if there was no CBCT .
Clinically exudation and deep periodontal pocket 10 mm nd grade 2 mobility seen . Trauma from occlusion .
Assuming this defect as seen in CBCT might fit into Goldman & Cohen classification of osseous defects .
Flap reflection after a papilla preservation flap . revealed granulation tissue but not the extent of bone loss , since had a picture of CBCT image in mind , thorough degranulation was done until I could see the extent of defect nd even tiny spec of granulation tissue removed , bone graft and membrane placed , good primary closure achieved .

Congenitally missing central incisor left upper tooth #21 referred by orthodontist .
Good soft tissue volume
Deficient hard tissue and proximity of nasopalatine canal structure as per CBCT evaluation .
Ridge expansion using densa drills , implant placed in 3 D .kw positioning GBR using autogenous bone scrape, allograft mineralized FDBA and xenograft layer, membrane used neomem bovine collagen , membrane stabilization by suture and passive closure of flap .
Initially temporary tooth Temporisation with essix retainer as patient was completing his Ortho treatment
Later chair side temporary tooth and final screw retained prosthesis delivered posted in story and highlight

4 reasons to choose TISSUE LEVEL ( TL) implant in posterior region .kw
1. Minimal intervention around PERIIMPLANT tissue
2. Less susceptibility to Perimplant disease
3. Intrabony diameter of Tissue level Implant in narrower than bone level implant , thus minimizes the need for a bone grafting procedure
4. The built in emergence profile for the transmucosal part can achieve an optimal emergence profile for posterior restoration.

Diplomate in Implantology by GCOI at Global Implant Symposium awarded by Prof Dr Ugo Covani and Prof Giovanni Manchini . Recieving the honours by Dr Tarun Kumar Sir for contributing as a emerging star Implantologist speaker. Immense gratitude to all the motivation support by .tarunkumar_implant sir, Dr Jaibin , management .

Perimplantitis treatment -
CIST- 1988 , the university of Bern school of dental medicine
Protocol for the treatment of Perimplant infections
- Mechanical debridement
- Antiseptic therapy
- Antibiotic therapy
- Regenerative / resective therapy
- As per CIST - metronidazole 250 mg TID for 10 days minimum.
Regenerative therapy done here
✨Debridement of the bone defect
✨Decontamination of the implant surface
✨Detoxification of the implant surface
✨Biomaterials used in this case
Allograft
Resorbable Collagen membrane
Collagen tape
Ora aid dressing
Steps
💥Identifing the cause of Perimplantitis and the parameter which could be changed and treated was implant prosthesis here and adjacent tooth treatment done by .aalali
Removed the old crown
Regenerative therapy steps as mentioned above
Healing period -3 months
Modified the implant prosthesis .
Follow up continued..and few more periimplantitis treatment post soon