I case study _ periodontal surgery Cosmetic periodontal surgery: Pre-prosthetic soft-tissue ridge augmentation (Part I) Author_ Dr David L. Hoexter, USA Fig. 1 Fig. 2 Fig. 1_Initial labial view of maxillary #9 edentulous area with a flipper. Fig. 2_Labial view of maxillary #9 edentulous area. _Dentists understand that patients demand outstanding aesthetic, as well as physiological, results in all phases of dentistry today. This places an onus on dentists, who must therefore be able to apply the latest technologies and techniques to achieve each patient’s unique aesthetic desires successfully. A successful aesthetic outcome requires knowing how to create the right illusion, which is subjective for each individual. Yet, it can be measured in objective and subjective standards. How then can practitioners evaluate and achieve these goals? To begin, there are certain basic and objective characteristics of a healthy periodontia that must first be observed, respected and maintained. A healthy periodontia is essential for achieving and maintaining restorative aesthetics. A reddish, inflamed periodontia immediately attracts negative attention to the area. In contrast, a healthy zone of pink attached gingiva acts as a subtle background, providing dentists with significantly more restorative options for teeth. Similarly, exposed gold crowns, gingival margins, exposed gingival porcelain jackets or laminate margins will draw negative attention. Also, crowns placed sub-gingivally in an inflamed area are likely to lead to recession and an irregular gingival pattern, resulting in dissatisfied patients. After healthy periodontia has been achieved, colour, hue, shape, form, symmetrical appearance and individual choice must then be discussed. At this point, the challenge of aesthetic dentistry is at its zenith. Part I of this series discusses the role of pre-prosthetic, cosmetic periodontal surgery to achieve and maintain a healthy periodontia and to aesthetically improve shape, colour, form and appearance. Clinicians should strive to achieve the appearance of a healthy symmetrical flow. For example, patients will not be satisfied with an oversized pontic placed in a large irregular edentulous area with a fixed bridge for long. It is unaesthetic and retains 06 I cosmetic dentistry 4_ 2009