case study _ periodontal surgery I Fig. 3 Fig. 4 Fig. 5 Fig. 6 food and plaque, which will lead to inflammation and periodontal disease. Often, a phonetic problem will also result. These patients will be thwarted in and frustrated by their hygiene efforts, and dissatisfied with the illusion of health and aesthetics that they sought to achieve. Therefore, the relationship of a pontic and the abutment teeth to the gingival must be observed critically before the prostheses are fabricated. By correcting the edentulous area aesthetically and physiologically with cosmetic periodontal surgery, a restorative dentist is able to fabricate a correctly shaped prosthesis that enhances aesthetics and function. It is important to make an assessment prior to fabricating the prostheses. In the past, large pontics were made to fill voids created by irregularly shaped, depressed edentulous ridges between abutments. The opportunity to build out and create a symmetrically harmonious bridge that blends in with the abutment’s periodontia is currently available. The following illustrates an example of treatment of one such case, resulting in a harmonious and aesthetically pleasing appearance. Fig. 3_Lateral view showing labial concavity depression. Fig. 4_Occlusal incisal edge view showing concave labial ridge. Fig. 5_Occlusal view of flap outline. Fig. 6_Reflected muco-gingival flap exposing osseous labial defect. _Case 1 A 25-year-old woman presented to the office very interested in achieving ideal aesthetics with a non-removable appliance. For years, she had been wearing a flipper removable replacement for her maxillary left central incisor (Fig. 1), which was traumatically lost in an accident when she was 15 years old (Fig. 2). Following the accident, it was suggested by her restorative dentist (because of her young age) Fig. 7_Gingival connective tissue graft placed in correct position. Fig. 8_The gingival graft is sutured to the flap, while the flap is repositioned and sutured for stability. Fig. 7 Fig. 8 cosmetic dentistry 4 _ 2009 I 07