Revisiting the Papilla in 2015 - Part 1 of 2
In dental esthetics the regeneration of a compromised papilla , remains the most complex aspect of any reconstructive endeavor. The original 5mm Rule was found to exist only for a papilla bordered by 2 teeth and was expanded into a classification of 6 Types dependent on alternative adjacent support.e. implants or pontics.

Excessive Gingival Display Managed by Surgical Lip Reposition, Aesthetic Crown Lengthening and Veneers
Excessive gingival display can be managed by a variety of treatment modalities, depending on the etiology. Mild and moderate gummy smiles can be successfully treated by periodontal plastic surgery, however for excessive gingival display as in cases of VME II or III with 5 to 8 mm or more of gingival exposure this procedure is not enough. Many patients decline the more invasive Le Fort osteotomy and opt for a less invasive surgical lip repositioning procedure. Currently Botox is used as alternative, but this is only a temporary treatment with very short effectiveness. That is why we suggest surgical lip repositioning as an effective procedure to reduce gingival display by positioning the upper lip in a more coronal location. The long-term stability of the results remains to be seen, but it holds promise as an alternative treatment to more invasive procedures.

Papilla Management in a Severe Periodontal and Cosmetic Deformity: Combining Veneer into Full Graft (ViFG) and Veneer into Split Graft (ViSG)
Bone defects and periodontal disease can create challenging defects in the anterior area. When we have such severe defects as the one presented here, it´s essential to plan in advance and to be sure of what is possible to correct with bone grafting and with soft tissue management. The key question in this clinical case is to be able to place the soft tissue graft exactly where you want it to heal. In our clinical practice we use routinely PRGF ENDORET grafts, not only as vehicle for particulate graft transportation, but also as a biological enhancer of both osteointegration and soft tiss

Revisiting the Papilla in 2016 - Part 2 of 2
While different surgical techniques can restore most aspects of a ridge deficiency,as part of the soft tissue restorative frame, the regeneration of lost proximal papilla form is surgically limited to those papillae bordered on each side by a pontic The Classification of 6 types of papilla defects is based on the specifics of the restorative support on either side of the individual site,and can therefore be a tooth, implant or pontic, or combinations of the 3.

Immediate Implant Provisionalization: A Critical Aspect in Tissue Care and Esthetics-Part 2
The management of the hopeless tooth or an edentulous span in the Estheitc Zone is amongst the most clinically demanding procedures in tooth replacement do to the demands of tissue preservation and patient management during the healing phase. As important as the implant surgical process in these areas is the role of the immediate provisional restoration. Tissue support, emergence profile and The provisional restoration phase of implant therapy has become one of the most critical steps in immediate or delayed placement for several reasons including the following...

Connective Tissue Graft Harvesting Techniques
In this presentation, Prof. Giovanni Zucchelli develops a critical comparison between the different CTG harvesting techniques, and shows the correct management of this kind of graft as well as its use in coronally advanced flap surgical technique for the treatment of gingival recessions.

Esthetic Periodontal Surgery: Making Recession Defects Disappear by Grafting
Expert discussion of soft tissue grafting; first an overview of current trends, the second showing a specific allograft technique for treating multiple adjacent recession defects.

Soft Tissue Enhancement After Implant Placement
Soft tissue management is one of the key factors for successful implant restoration. Esthetics can be strongly influenced by the conditions of the peri-implant tissue. Substantial knowledge of tissue anatomy and biology is a fundamental prerequisite for surgical success. The present chapter introduces different techniques to improve the appearance of the soft tissue after implant placement. Cases of repositioned flaps, FGGs, and CTGs are presented along with biological considerations. It was our intention to present various indications and options to the clinician to achieve an increased amount of peri-implant KG or connective tissue thickness.

Use of the Subepithelial Connective Tissue Graft to Improve Esthetics
The subepithelial connective tissue graft is a gingival grafting plastic surgery procedure that can be used to enhance the aesthetic and gingival contour of the periodontium around dental implants. This technique is described and illustrated to create a soft-tissue root prominence and mask the grey color penetrating the thin labial attached gingival tissues over dental implants.

Healing of Gingival Recessions Using a Collagen Membrane with a Demineralized Xenograft
A Randomized Controlled Clinical Trial