Andreina Izarra, DMD

A case to prove I don’t do FGGS on all my implants!!! . This case takes you on a patient’s journey to replace his LL quadrant with implants. His bridge broke 17-x-x-20 and the teeth deemed unresturable. It makes me wonder if this would have happened if the bridge would have been double abutted on the 20 and 21 The first surgery, I removed teeth 17 and 20 and grafted both the extraction sites as well as the edentulous sites 18, 19 for width. The second surgery I placed imp...lants at sites 18 and 20 for a 3 unit bridge. I used ossix volumax folded in half to bulk out the soft tissue contour where there was a slight deficiency. On a side note this patient is in his early 90’s so bottom line it’s never to let to get implants. He just wanted to chew and enjoy his food better! Can you blame him? How inspiring Would you have grafted this slight deficiency? And if so with what? #buckheadperiodontist #atlantaperiodontist #dentalimplants #oralsurgery #bonegraft #nobelbiocare #orapharma #ossixvolumax #periodoncia #implantesdentales #womenindentistry #womenperiodontists @ Buckhead Atlanta

I caved in and harvested a DE-EPITHELIALIZED FGG for a CT tunneling root coverage procedure!!! I’ve been hearing and reading about its superior fibrous quality, ease of handling/ tunneling and root coverage outcomes. I first harvested a traditional FGG and then used a 15 scalpel to remove the epithelial layer. It ended up being really simple and I loved its characteristics. I harvested two grafts and you can see the difference between them in the process. Looking back at the... surgery, I did not need to take as thick and wide of FGG but I didn’t know how much it would shrink or what I’d be left with after removing the epithelium. Final thoughts, I will definitely do this again and can’t wait to see the final results of this case! Have you tried this technique in your offices and if so what has been your experience? Would you have done anything differently? If you haven’t done this technique, what’s been holding you back? #periodontalplasticsurgery #periodoncia #buckheadperiodontist #atlantaperiodontist #periodontist #womenindentistry #womenperiodontists #cosmeticdentistry #plasticsurgery #connectivetissuegraft #gumgrafting

FGGs are making a comeback! Although this case is a throwback because it was done in my first few years of private practice, I would still choose a FGG Not to beat a dead horse but FGGs can: increase attached zone of KT remove aberrant frenums... increase vestibular depth improve gingival thickness (biotype) cover root surfaces (although less predictable than CTG, it’s still possible) * Partial root coverage in this case. This patient was anticipating orthodontic movement to correct her large open bite. Look at her MICP They we’re planning on a lot of movement on teeth that were periodontally compromised with CAL and minimal to no attached KT. I wish I would have followed up with this case throughout the ortho process but the truth is I moved across the country sometime during her treatment. When I see my old cases I can’t help but critique my technique and compare it to how I would do things now after years of experience. Believe me there is a lot I would do differently now! That being said, this result was pretty solid for a kid straight out of residency! What would you have done differently? Would have included 22 and 27 in the graft? #buckheadperiodontist #atlantaperiodontist #periodoncia #freegingivalgraft #makefggsgreatagain #periodontalplasticsurgery #gingivalgraft #womenindentistry @ Buckhead Atlanta

Happy Monday Friends! Let’s talk about ridge augmentation at the time of implant placement. It’s not only important for implant stability but also for creating a the final ridge contour that looks natural. For this patient, he had a congenitally missing tooth #7 and the orthodontist made space for the implant as the roots converged in this area. At the time of implant placement I horizontally augmented the ridge using a mineralized cortical cancellous allograft mixed with iP...RF to make sticky bone and then covered it with an ossix plus membrane and PRF membranes over the collagen. I am personally loving how the sticky bone handles. The bone particles actually stay where you place them. You can see how the healing looked at 2 and 4 weeks. I removed sutures at 4 weeks. I was very happy with the width that was achieved. I know it will shrink a bit during the next few months so moral of the story is overfill your bone graft! Do not be shy. You’ll notice that we did lose a tiny bit of the distal papilla of #8 but there is still some tissue maturation that will occur before I uncover this bad boy. Would you have tackled this any different (surgical technique, biomaterials)? Any thoughts on how you would design your uncovery incisions to optimize esthetics? Let me know your thoughts below! #buckheadperiodontist #atlantaperiodontist #womenindentistry #implantdentistry #ridgeaugmentation #bonegraft #dentalimplants #cosmeticdentistry #periodontics #periodoncia #implantologia #ridgedeficiency @ Tuxedo Center Building

FGG healing! Previously I posted similar case in which a FGG was done at the time of implant uncovery. I showed how the healing can sometimes be unsightly. In this case the healing was very different. Photos are immediately post-operatively, at 2 weeks, at 4 weeks, and 8 weeks. Lately my healings look more like this and I can’t help but wonder if it’s due to the microsurgical techniques I have incorporated in my soft tissue surgeries. Nonetheless, it amazes me how differently... two people can heal from a very similar procedure! What have you noticed in your practices? Does the healing even matter as long as the final outcome is acceptable? Why do I feel better when the healing looks like this? #microsurgery #dentalsurgery #freegingivalgraft #periodontalplasticsurgery #periodontics #buckheadperiodontist #atlantaperiodontist #makefggsgreatagain #womenindentistry #dentalimplants #periodoncia @ Tuxedo Center Building

Bread and butter implant dentistry Implant placement with a minimally-invasive crestal approach sinus lift. I used the #hiossen CAS kit with a #biomet3i implant to replace tooth 14. We just got the Versah burs at the office and I have been meaning to try them for cases like this. Do you have any tips for me? #dentalimplants #implantdentistry #buckheadperiodontist #buckheadperiodontics #atlantaperiodontist #cosmeticdentist #periodontics #periodoncia @ Buckhead Atlanta

An Immediate implant placement following the atraumatic extraction of #30. The presence of the furcal bone was crucial for getting primary stability of the implant. A flap was not elevated as the buccal and lingual plates were intact. Particulate bone allograft was placed in the sockets and no attempt for primary closure was made. You can see the fast healing at the two weeks post-op. I typically don’t do a ton of immediate implants at molar sites but curious what everyone... else is doing? What’s your criteria? #buckheadperiodontist #atlantaperiodontist #periodontist #periodoncia #immediateimplant #dentalsurgery #implantdentistry #dentalimplants #bonegraft #biohorizonsimplants

The healing of a FGG is not always pretty! Swipe through the healing of this graft at 6 days, 14 days, 22 days and 42 days. It will always look worst at 7-14 days until the top epithelial later exfoliates. The most common concern from patients is that they think the graft is infected when in fact it’s part of the normal healing. This case was done a few years ago and since then my techniques have trended towards using microsurgical principles. Since then, I am seeing fas...ter and improved healing. Perhaps it’s reduced thickness of the FGG. Has anyone had a similar experience? #buckheadperiodontist #atlantaperiodontist #periodontist #buckheaddentist #atlantadentist #periodoncia #FGG #makeFggsgreatagain #periodontalplasticsurgery #implantdentistry #biohorizonsimplants #gingivalgrafting @ Tuxedo Center Building

I am so disappointed that I don’t have photos of the ridge augmentation surgery but this is the result at the time of re-entry and implant placement. Pretty happy with the amount of bone I had to work with! #implantdentistry #buckheaddentist #buckheadperiodontist #oralsurgery #ridgeaugmentation #dentalimplants #periodontics #periodoncia #bonegraft @ Buckhead Atlanta

Who are my dental colleagues out there who have successfully incorporated Botox and dermal fillers into your dental practice? Tell me your story...How did you do it and what courses did you take to master your skills? I have taken the AAFE’s level 1 course series and well as their master lips courses. The great thing about them is they are live patient training courses and not just didactic. Send me some recommendations on what courses or private training I should look int...o next! ***The after photo was taken 2 weeks after Botox administration on his crows feet. #atlantadentist #atlantaperiodontist #buckheadperiodontist #botoxbeforeandafter #brotoxformen #crowsfeet #crowsfeetbotox #aafe

There are countless ways to skin a cat!!! In this gingival recession case I chose to do an envelope flap with a connective tissue graft. I was able to obtain full root coverage on #6 and gain some soft tissue thickness and attached gingiva! I do think this type of mucogingival defect could be treated successfully using other treatment modalities. I am interested in hearing how you would treat this? Would you flap or tunnel? Would you choose autogenous or allograft tissue? Wo...uld you harvest FGG or CTG? Share your thoughts below... #periodontist #periodoncia #atlantadentist #atlantaperiodontist #atlanta #softtissuegrafting #connectivetissuegraft #periodontalplasticsurgery #womendentists #womenindentistry

Putting this case together reminded me of why I love periodontics and why I miss practicing so much. I knew going into surgery because of the interproximal attachment loss that we would likely not achieve 100% root coverage. That being said I was really happy with the improvement in prognosis and esthetics! Most importantly I had a happy patient @ Atlanta, Georgia