To Graft or Not to Graft with Dr. David Wong

Join Elevated GP: https://www.theelevatedgp.com/  Do you ever feel like you're on an island in this profession, unsure of whether to monitor a case or hit the panic button? You are not alone. In this episode of Dental Digest, host Dr. Melissa Seibert sits down with board-certified periodontist Dr. David Wong to clear up the confusion surrounding soft tissue defects, gingival recession, and grafting thresholds. If you've ever looked at a patient with root exposure and wondered if a connective tissue graft is truly necessary, this deep dive into evidence-based periodontics is exactly what you need. Dr. Wong breaks down his exact clinical decision-making framework, detailing how to evaluate tissue phenotypes, measure keratinized vs. attached tissue thresholds, and factor in radiographic bone height. They also tackle the notorious "sensitivity trap" and outline exactly when a prominent root or complex defect requires an advanced ridge rebuild versus a conservative watch-and-wait approach. 🚀 What You'll Learn in This Episode: The Grafting Checklist: How to confidently make the call on whether a soft tissue defect requires surgical intervention. Phenotypes & Recession: Understanding the structural thresholds (in millimeters) that signal a high risk for progressive recession. Attached vs. Keratinized Tissue: How much attached tissue is actually enough to maintain long-term periodontal health? The Sensitivity Trap: Why treating root sensitivity with a connective tissue graft might have clinical limits, and what to look for instead. Interproximal Bone Loss: How radiographic height influences your soft tissue prognosis and surgical outcomes. 👨‍⚕️ About the Guest: Dr. David Wong is a board-certified periodontist who completed his training at the University of Missouri-Kansas City. He serves as a chief examiner, holds an advanced credentials certificate from the Misch International Implant Institute, and is a Fellow of the Congress of Oral Implantologists. With decades of clinical experience, Dr. Wong is a leading expert in rebuilding ridges and advanced implant plastic surgery. This episode is brought to you in partnership with Elevate GP—the premier virtual study club for general dentists striving for clinical excellence. Stop practicing alone and join a live community getting their toughest case questions answered every single day.     Dental podcast, Dr. Melissa Seibert, Dental Digest, Dr. David Wong, soft tissue grafting, gingival recession, periodontist, general dentists, connective tissue graft, keratinized tissue, dental implant surgery, Elevate GP.

Elevated GP - Click here to join Elevated.GP Follow @dr.melissa_seibert on Instagram Dr. Peter Milgrom is Professor of Oral Health Sciences and Pediatric Dentistry in the School of Dentistry and adjunct Professor of Health Services in the School of Public Health at the University of Washington. He directs the Northwest Center to Reduce Oral Health Disparities. He holds academic appointments at Case Western University, University of Rochester, and University of California, San Francisco. He maintains a dental practice limited to the care of fearful patients and served as Director of the UW Dental Fears Research Clinic. Dr. Milgrom's work includes research on xylitol, the effectiveness of fluoride varnish and iodine in preschoolers, clinical efficacy and safety of diammine silver fluoride, motivational strategies to increase perinatal and well child dental visits in rural communities, and studies of cognitive interventions in pediatric and adult dental fear. The NIH, Maternal and Child Health Bureau, HRSA, and the Robert Wood Johnson Foundation support his work. Dr. Milgrom is author of 5 books and over 300 scientific articles. His latest book, Treating Fearful Dental Patients, was published in 2009.   Dr. Milgrom was Distinguished Dental Behavioral Scientist of the International Association for Dental Research for 1999. In 1999, and again in 2000, his work was recognized by the Giddon Award for research in the behavioral sciences in Dentistry. He received the Barrows Milk Award from IADR in 2000, recognizing his work for public health including the development of the Access to Baby and Child Dentistry (ABCD) program in Washington State. In 2003, Dr. Milgrom received a Special Commendation Award from the National Legal Aid and Defenders Association and the University of Washington Medical Center Martin Luther King, Jr. Community Service Award. In 2010, he received the Aubrey Sheiham Research Award for his work on xylitol. He serves on scientific review committees for the NIDCR, NIMHHD, NINDS, Center for Scientific Review at NIH and as a consultant to the FDA. In 2005, Dr. Milgrom was appointed the SAAD Visiting Professor of Pain and Anxiety Control at the King's College Dental Institute, University of London, UK for a six-year term. In 2008 he was awarded the degree of Doctor Honoris Causa from the University of Bergen, Norway in recognition of his work in social and behavioral dentistry. In 2012, he received the University of California, San Francisco Dental Alumni Gold Medal for his contributions to Dentistry. In 2012 he was also awarded the Norton Ross Award for Excellence in Clinical Research by the American Dental Association. In 2013, he was appointed to the Council of Scientific Affairs of the American Dental Association. In 2014, he received the Irwin M. Mandel Distinguished Mentor Award from the IADR. In 2015, he served as HMDP Expert in Dental Public Health for the Singapore Ministry of Health. Dr. Milgrom received his DDS from the University of California, San Francisco in 1972 and had a previous position at the National Academy of Sciences, Engineering, and Medicine. In the last few years, Dr. Milgrom has spoken to dental associations in Argentina, Colombia, Peru, Philippines, and USA and at major universities in USA and abroad.

Join Elevated GP: www.theelevatedgp.com Register for the live meeting: https://www.theelevatedgp.com/ElevationSummit Download the Injection Molding Guide: https://www.theelevatedgp.com/IMpdf    What separates good veneer dentistry from truly exceptional aesthetic dentistry? In Part 2 of this in-depth conversation on Digital Dentist Digest, Dr. Melissa Seibert sits down with legendary prosthodontist and aesthetic dentistry educator Dr. Gerald Chiche to explore the clinical nuances, preparation strategies, and decision-making principles behind predictable porcelain veneer treatment.   Dr. Chiche, former president of the American Academy of Esthetic Dentistry and internationally recognized leader in aesthetic dentistry, shares decades of experience performing veneers with a strong emphasis on minimally invasive preparation design, enamel preservation, and long-term restorative success.    In this episode, Dr. Chiche walks through his additive veneer preparation workflow, including mock-up transfers, bisacryl matrices, depth-cut strategies, and techniques for staying predictably in enamel to maximize bond durability. He explains why preserving enamel remains one of the most important principles in adhesive dentistry and how thoughtful preparation design directly impacts the longevity of porcelain veneers.   The conversation also covers gingival management, cord packing techniques, impression accuracy, proximal preparation design, and margin placement in aesthetic cases. Dr. Chiche shares practical clinical pearls for managing difficult scenarios such as tetracycline staining, dark preparations, black triangles, and patients requesting highly translucent veneers despite significant discoloration challenges.   Beyond technique, this episode focuses heavily on clinical judgment and patient communication. Dr. Chiche discusses how to determine when veneers are the right treatment, when direct bonding may be a better option, and how informed consent and expectation management are essential in elective cosmetic dentistry. He also explains why collaboration with skilled ceramists and careful mock-up evaluation remain foundational to achieving natural, long-lasting aesthetic results.   This episode is ideal for general dentists, cosmetic dentists, prosthodontists, and clinicians interested in porcelain veneers, smile design, adhesive dentistry, and minimally invasive aesthetic treatment planning. Whether you are refining your veneer workflow or looking to strengthen your understanding of aesthetic case selection, this conversation offers practical insights grounded in decades of clinical excellence and evidence-based dentistry.

Join Elevated GP: www.theelevatedgp.com Register for the live meeting: https://www.theelevatedgp.com/ElevationSummit Download the Injection Molding Guide: https://www.theelevatedgp.com/IMpdf 

Join Elevated GP: www.theelevatedgp.com Register for the live meeting: https://www.theelevatedgp.com/ElevationSummit Download the Injection Molding Guide: https://www.theelevatedgp.com/IMpdf    What does truly conservative, evidence-based dentistry look like when treating tooth wear patients? In Part 2 of this conversation on Digital Dentist Digest, Dr. Melissa Seibert continues her discussion with internationally respected adhesive dentistry expert Dr. Didier Dietschi, diving deeper into the clinical execution, biomechanics, and decision-making behind minimally invasive restorative dentistry.   Dr. Dietschi, senior lecturer at the University of Geneva and internationally recognized authority in adhesive and aesthetic dentistry, explains how dentists can move beyond "copy-and-paste" full mouth rehabilitation and instead develop individualized treatment plans based on patient age, risk factors, compliance, biomechanics, and long-term prognosis.    In this episode, Dr. Dietschi discusses how to evaluate tooth wear severity, determine when restorative intervention is actually necessary, and decide between composite, ceramic, or hybrid treatment approaches. He shares his philosophy on preserving tooth structure, avoiding unnecessary invasiveness, and understanding the biological cost of aggressive dentistry—especially in younger patients with bruxism, clenching, erosion, and parafunctional habits.   The conversation also explores the real-world challenges dentists face when managing wear patients, including nightguard compliance, restorative maintenance, patient communication, and the emotional burden clinicians often feel when restorations chip or fail. Dr. Dietschi offers a refreshingly honest perspective on responsibility, patient behavior, and why long-term success in restorative dentistry depends on far more than simply choosing a stronger material.   Listeners will also gain valuable insight into adhesive dentistry, vertical dimension management, composite layering and molding techniques, occlusal risk assessment, and the importance of tailoring restorative materials to specific clinical situations rather than relying on a one-material-fits-all philosophy.   This episode is ideal for general dentists, restorative dentists, and clinicians who want to think more critically about comprehensive treatment planning, minimally invasive dentistry, and long-term patient care. If you are interested in biomaterials, tooth wear management, occlusion, and evidence-based restorative dentistry, this conversation provides both practical clinical guidance and a broader philosophical framework for modern practice.

Join Elevated GP: www.theelevatedgp.com Register for the live meeting: https://www.theelevatedgp.com/ElevationSummit Download the Injection Molding Guide: https://www.theelevatedgp.com/IMpdf    What if the future of treating tooth wear is not full-mouth ceramic rehabilitation? In this episode of Digital Dentist Digest, Dr. Melissa Seibert sits down with internationally recognized researcher and clinician Dr. Didier Dietschi for a thought-provoking conversation about minimally invasive dentistry, adhesive restorations, and the long-term management of tooth wear patients.   Dr. Dietschi, senior lecturer at the University of Geneva and a globally respected authority in adhesive and aesthetic dentistry, challenges the increasingly common "28-ceramic restoration" philosophy that has become prevalent in modern restorative dentistry. Instead, he advocates for a more individualized, interceptive, and biologically conservative approach to treatment planning.    Throughout the episode, Dr. Dietschi explains why dentists must focus on identifying the underlying etiology of tooth wear—including attrition, erosion, bruxism, clenching, occlusal anatomy, and parafunctional habits—before jumping to irreversible treatment. He discusses the long-term risks associated with aggressive full-mouth rehabilitation, particularly in younger patients, and why delaying invasive treatment is often the most ethical and predictable strategy.   The conversation also explores the advantages and limitations of composite restorations versus ceramics, how risk factors like heavy bruxism and poor compliance impact restorative longevity, and why prevention and patient education remain central to successful outcomes. Dr. Dietschi shares his clinical workflow for evaluating wear patterns, assessing biomechanical risk, implementing interceptive protocols, and improving patient compliance with nightguards and long-term maintenance.   This episode is packed with practical insight for general dentists, restorative dentists, and clinicians who want to improve treatment planning, preserve tooth structure, and think more critically about comprehensive rehabilitation cases. Whether you regularly manage wear patients or are trying to become more conservative and evidence-based in your restorative philosophy, this conversation offers a refreshing and clinically grounded perspective on modern dentistry.   

Join Elevated GP: www.theelevatedgp.com Register for the live meeting: https://www.theelevatedgp.com/ElevationSummit Download the Injection Molding Guide: https://www.theelevatedgp.com/IMpdf    What happens when a patient's oral symptoms are actually the first warning signs of a much larger systemic health issue? In this episode of Digital Dentist Digest, Dr. Melissa Seibert welcomes Dr. Natalia Trahan, Assistant Professor at the Medical University of South Carolina, for a deep and clinically relevant conversation on the relationship between systemic disease and oral health.   Dr. Trahan specializes in oral medicine, pathology, and radiology, with a strong focus on the intersection of oral and systemic disease. Together, they discuss how conditions like Sjögren's Disease, Rheumatoid Arthritis, Fibromyalgia, Ehlers-Danlos Syndrome, Juvenile Idiopathic Arthritis, and Postural Orthostatic Tachycardia Syndrome can present first in the dental office—often before a formal medical diagnosis is made.   This episode explores practical diagnostic strategies for identifying oral manifestations of autoimmune disease, including xerostomia, hyposalivation, chronic parotitis, recurrent candidiasis, increased caries risk, TMJ degeneration, trismus, hypermobility disorders, and inflammatory arthritis involving the temporomandibular joint. Dr. Trahan explains how she evaluates these patients clinically, what radiographic findings matter most, and when advanced imaging like MRI becomes essential for proper diagnosis and treatment planning.   The conversation also addresses the emotional and clinical complexity of treating patients with chronic pain conditions such as fibromyalgia and connective tissue disorders like Ehlers-Danlos Syndrome. Dr. Trahan shares how empathy, patient advocacy, and a deeper understanding of autoimmune and rheumatic disease can transform the way dentists approach patient care and prevent provider burnout.   For general dentists, restorative dentists, and clinicians interested in oral medicine, this episode offers actionable insight into how better understanding systemic disease leads to better dentistry. If you want to improve diagnosis, strengthen interdisciplinary care, and become a more comprehensive provider, this is an episode you won't want to miss.  

Join Elevated GP: www.theelevatedgp.com Register for the live meeting: https://www.theelevatedgp.com/ElevationSummit Download the Injection Molding Guide: https://www.theelevatedgp.com/IMpdf    How often do systemic diseases first reveal themselves in the dental chair? In this episode of Digital Dentist Digest, Dr. Melissa Seibert sits down with Dr. Natalia Trahan, Assistant Professor at the Medical University of South Carolina, to explore the critical connection between systemic health and oral health.   Dr. Trahan shares her expertise in oral medicine, pathology, and radiology, with a special focus on how conditions like Sjögren's Disease, Rheumatoid Arthritis, Fibromyalgia, Ehlers-Danlos Syndrome, Postural Orthostatic Tachycardia Syndrome, and autoimmune disorders present with oral symptoms that dentists often encounter first.   The conversation dives into xerostomia, hyposalivation, parotitis, TMJ involvement, chronic pain conditions, inflammatory arthritis, and the importance of recognizing when oral symptoms are actually signs of larger systemic health concerns. Dr. Trahan also explains how dentists can improve diagnosis and treatment planning by looking beyond the oral cavity and considering the full patient picture.   This episode is especially valuable for dentists who want to strengthen their diagnostic skills, improve patient communication, and deliver more compassionate, comprehensive care for medically complex patients. From interpreting panoramic radiographs and MRI findings to understanding autoimmune disease progression and the role of empathy in patient care, this episode offers practical clinical insight every GP can apply immediately.   If you're looking to stay on the cutting edge of evidence-based dentistry, oral-systemic health, and comprehensive patient care, this episode is a must-listen.

Join Elevated GP: www.theelevatedgp.com Download my free Injection Molding PDF Guide Follow @dental_digest_podcast Instagram Follow @dr.melissa_seibert on Instagram In this in-depth conversation, Dr. Melissa Seibert is joined by prosthodontist and Spear Education faculty member Dr. Kim Schlam to take a critical look at one of the most talked-about trends in dentistry: full-arch implant reconstructions and hybrid prostheses. Together, they explore the promises and pitfalls of these complex treatments, challenging the idea that hybrids should be considered a one-size-fits-all solution. Dr. Schlam shares candid insights from years of managing both the successes and failures of full-arch implant therapy. She reminds us of the original purpose of dental implants—addressing the devastating effects of mandibular edentulism—and contrasts that with today's market-driven push for hybrids as a default treatment. Their discussion highlights the importance of careful case selection, interdisciplinary planning, and viewing each patient as a human being rather than a set of "arches." Listeners will gain a deeper understanding of how digital workflows can support precision and predictability, but also why long-term maintenance protocols, prosthetic follow-up, and patient education are critical for lasting outcomes. From the ethical implications of overtreatment to the biomechanical realities that distinguish implants from natural teeth, Dr. Schlam advocates for a philosophy of dentistry that prioritizes rehabilitation, not just replacement. This episode is a must-listen for dentists who want to think critically about full-arch implant solutions, expand their understanding of restorative decision-making, and elevate their approach to truly patient-centered care

Join Elevated GP: www.theelevatedgp.com Connect with me on Instagram at @dr.melissa_seibert on Instagram Van B. Haywood, D.M.D., is Professor Emeritus in the Department of Restorative Sciences, Dental College of Georgia @ Augusta University.  A 1974 alumni of the Medical College of Georgia School of Dentistry, he was in private practice 7 years in Augusta, Georgia and taught at the University of North Carolina School of Dentistry in Chapel Hill, NC in Operative and Prosthodontics for 12 years before coming to Augusta University in 1993. In 1989, he co-authored the first publication in the world on Nightguard vital bleaching (at-home tray bleaching) with Dr. Harald Heymann, and in 1997 co-authored the first article on extended treatment (six-months) of tetracycline-stained teeth using this technique.While he is most known for his research and articles on tray bleaching, he taught in the Fixed Prosthodontics courses, the Occlusion courses,and the Esthetics course, as well as in sophomore and junior Operative and Fixed student clinics. After over 29 years at the Dental College of Georgia, he retired from full-time teaching in December 2022. The DCG Class of 1997 initiated a scholarship in his name for clinical excellence and compassionate care.