A captivating smile reflects inner confidence and well-being, and the aesthetic zone holds a central place in this expression. The challenge arises when severe periodontal disease threatens the health and appearance of this vital area. Although the palatal approach to treating periodontal disease in the maxillary anterior sextant has been around for decades, it is almost a forgotten art. However, it can be a game changer and a win-win for both patient and clinician (Click here to view our case of the month).

Today, we'll delve into the significance of the aesthetic zone, the hurdles it poses, and the innovative palatal approach that is revolutionizing periodontal treatment.

The Aesthetic Zone: A Window to Confidence

The aesthetic zone, encompassing the front teeth prominently displayed during a smile, is a canvas of individual beauty and charm. Disruptions caused by periodontal disease can lead to gum inflammation, recession, and bone loss, casting shadows over this prized feature. Traditionally, addressing gum disease in this area involved surgical interventions from the facial side of the teeth, which oftentimes resulted in undesirable aesthetic outcomes – dark triangles, unwanted spitting, food impaction, increased mobility, and an unesthetic smile.

The Palatal Approach

A few years ago, I was invited by the International Society of Periodontal Plastic Surgery to give a lecture on the palatal approach to preserving anterior esthetics. Dr. PD Miller, one of the society’s founders, was in the room and encouraged me to publish my technique and the 30-year follow-up. In 2018, the results were published (Papillary Retention Flap Design for Pocket Reduction/Regeneration: Case Series with Long-Term Follow-Up Sonick, Ma, Hwang, Compendium September 2019, Vol 39, No 8) Click here to view.

This predictable technique has transformed the landscape of periodontal therapy while preserving smile aesthetics. It is a fresh perspective on an older technique in the treatment of periodontal disease in the aesthetic zone. Pocketing is eliminated and esthetics are preserved. We will be talking more about this in our Periodontal Mastery Program at NYU on November 1-3, 2023 (Click here to learn more and register) I also just filmed a video introduction you can view here.

The key is treating the patient from the palatal side of the teeth.  Flaps are not elevated labially, and the delicate interdental papillae are preserved.  These papillae play a pivotal role in esthetics and patient comfort. Surgical regeneration of the papillae is not predictable.  Maintaining the integrity of these papillae while addressing periodontal disease is essential to ensure a visually appearing dentition.

Benefits of the Palatal Approach

• Papillary Preservation: The palatal approach prioritizes the preservation of the interdental papillae, which are crucial for creating natural-looking and harmonious smile aesthetics.

• Aesthetic Harmony: By treating periodontal disease from the palatal side, the risk of altering the appearance of the gumline or causing facial tissue defects is minimized, resulting in a smile that remains aesthetically pleasing.

• Enhanced Precision: The palatal approach enables precision in targeting the affected areas while minimizing discomfort and promoting faster healing compared to traditional surgical techniques.

• Innovative Regeneration: The technique facilitates the application of regenerative materials, placed from a palatal approach, to promote the restoration of lost gum and bone tissue, further enhancing the aesthetic outcome.

Conclusion

The palatal approach to treating periodontal disease in the aesthetic zone is predictable with over 30 years of well documented follow-up. This has become a forgotten art and its reinstitution can lead to a shift in the way we think about our patients. Our goals have always been the elimination of disease and a return to periodontal health. However, many of our dental ancestors achieved this with full-thickness flaps and aesthetic disfigurement.

By embracing this innovative technique, patients can confidently address periodontal concerns while retaining the natural beauty of their smiles. The palatal approach propels us toward achieving this noble vision, allowing individuals to unlock the full potential of their smiles, radiating health, beauty, and self-assurance.

It is our duty to treat the patient as an individual as we would want to be treated. As I suggest in my book and in courses, we treat people who happen to be patients (Click here to learn more). The palatal approach in the esthetic zone helps us achieve that vision.