I case study _ periodontal surgery Fig. 9a Fig. 9a_Initial lateral view of depressed area. Fig. 9b_Healed ridge augmentation, lateral view. Fig. 9b that she avoid a permanent splint and wait for the pulps of the adjacent teeth to mature. Years later, she was referred to me for pre-prosthetic cosmetic surgery that would allow for a non-removable, aesthetically pleasing and physiologically maintainable appliance. Without the surgery, the permanent replacement would have been a large bulky pontic or physiologically sized pontic, which would have retained food and plaque because of a void between the gingival space of the pontic and the crest of the edentulous ridge. This void would then have created a dark and unaesthetic contrast. If the pontic had been smaller, there would have been a space between the pontic and the edentulous ridge in which food and plaque would also be retained. If a removable appliance had been fabricated, the practitioner might have achieved an acrylic colour that somewhat resembled the pinkish gingival area, but it would have been discernible. If a clasp partial was used for the removable prostheses, the clasp would have been unsightly. An attachment-type partial would require crowns to be prepared on the remaining abutments, and the contrast of the replacement tooth would have been detected next to the adjacent abutments. Either partial would have been an obvious replacement that contrasted with the adjacent teeth. After consultation, it was determined that by using a combination of periodontal surgery techniques, the shape, height and form of the ridge could be corrected, enabling the restorative dentist Fig. 10 Fig. 11 Fig. 10_Buccal view of a posterior maxillary area with an extreme depression defect. Fig. 11_Occlusal view of the same posterior defect without provisional prosthesis. Fig. 12_Anterior-buccal view of same defect. Fig. 13_Tissue ridge augmentation completed in posterior with new provisional; note the physiological and aesthetic enhancement. Fig. 12 Fig. 13 08 I cosmetic dentistry 4_ 2009