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    47 year old female who isn’t happy with her recession presents for evaluation.
    A year ago she had conservative semilunar incisions done elsewhere to try to
    advance the gingival margin but the patient feels this had no effect at all.
    PMH: SLE (Lupus) which the patient states is largely in remission due to
    treatment with Plaquenil, methotrexate and prednisone 5mg QD. She states
    her rheumatologist is going to d/c the methotrexate soon. Non-smoker, good
    hygiene. high smile line with several mm of gingival display.

    What do you do?

    A) autogenous CTG with coronal advancement
    B) cadaver CTG of your choice with coronal advancement
    C) addition of biologic enhancers (GEM-21, EMD, PRP, etc.)?
    D) open vs. tunneled?
    E) tell her you can’t help her – too risky. In which case, what would
    you do if she was healthy and on no meds?




    I treated a case like that with AlloDerm several years ago, although my patient was not immunocompromised like yours. This was AlloDerm without any adjuncts other than a Zpack.

    All the best,




    Do you feel that the interproximal suspensory sutures (I believe you used 7-0 Goretex) really make a difference? I do virtually the exact same suture technique as you showed, just without the suspensories. I can’t imagine a patient is too happy walking around for a week or two with those sutures down to the incisal edges. My patients would kill me! What magic do you use to prevent your patients from being too upset about those sutures?

    Thanks for the excellent contribution you’ve added to this forum.



    I learned that technique from Peter Nordland. I just tell them that Dr. Nordland said I have to do it…

    If they complain about that then they would really complain about the perio pack for 2 weeks!!

    All the best,


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