Managing Severe Periodontal Esthetic Challenges: The Restorative-Surgical Connection

When treating patients with severe periodontal disease, dentists often face the difficult dilemma of how to effectively treat the disease while satisfying patient esthetic demands. Care must be taken to evaluate the patient's periodontal anatomy and the position of the planned prosthetic margin to ensure proper development of the biologic architecture. The treatment goals for this patient included exposure of adequate tooth structure for the placement of a restorative margin, establishment of a healthy dentogingival complex, and the subsequent fabrication of a well-fitting, esthetically pleasing definitive restoration. This article presents a case where careful communication between the restorative dentist, the periodontal surgeon, and the laboratory technician resulted in a predictable esthetic and restorative outcome while improving the periodontal health of the patient. Key to this collaboration was the use of a structured treatment-planning protocol and the fabrication of a realistic cast, which represented the three-dimensional anterior soft tissue architecture as it was present in the patient's mouth.