everybody's if Simon here welcome to this video and in this video I wanted to talk about a very common problem that I see among my patients coming to my practice whether they're existing patients or refer to my practice by different dentists and other specialists and I wanted to talk about am you coach interval defect or am you coach interval problem and what do I mean by that if you understand how the gingiva or the soft tissues drape around teeth we're looking at two parts of the ginger one is called the attached tissue which is close to the tooth surface and it's usually keratinized it's densely attached to the underlying bone just below it to a pickle - it starts the alveolar mucosa is considered non attached it's totally different it has a lot of the lasting in it and many times you'll see a freedom pole or what I call a mucosal pole connecting to the lower lip upper lip and the buccal mucosa so what is the mucilage interval defect is when you don't have enough attachment karate nice tissue and the gingiva is consistent mostly of mucosa so why is this a problem first of all the most common area of of these problems is the low incisor area and it's non aesthetic when a lot of patients are not bothered by it they don't have any significant sensitivity definitely noise no aesthetic concerns and then then they come and see me and I tell them that it is a problem and they need treatment they need this surgery that sometimes hurts and is not inexpensive so in this video I wanted just to discuss this particular case that was this patient was referred to me and go over the finding and then in the next video next week I'm going to show you something really interesting it's the consequence of no treatment let's start by looking at this photograph and the concern was with some slight recession there were no actual symptoms and it's in the lower incisor region tooth number 25 had about two to three millimeters of recession some inflammation the best way to to look at these situations and this is my my first tip of this video is if you don't understand the situation or a clinical or some clinical circumstances just describe describe what you sing and that would lead you to a diagnosis and based on that you can start figuring out what would be the best treatment plan so if you look at tooth number 25 number one you see ginger or recession you see the tissue that has been retracted in an apical direction you see inflammation and you also see a very thin layer of keratinized tissue very thin layer and you can definitely tell the the board or the the difference between keratinized tissue and non-keratinized tissue and it's a different in color it's different in tissue consistency so tooth number 25 is very little keratinization but what's even more important is that this tooth has no attachment because when you probe on the mid buccal area of this tooth the probing death was about three to four millimeters meaning the tip of the probe is inside the alveolar mucosa and that means that this particular tooth has no attached tissue which is a problem and if you look carefully just from a different angle if you pull the lip either to the stupa to this from side to side you'll see also a frenum Pula mucosa Pole and that's a contributing factor to the recession so the real big question here is what can be done what is the problem what is the consequence of no treatment my recommendation is to perform a free gingival graft to improve the tissue quality eliminate the tissue poor get a little bit of fruit coverage and mostly prevent further recession so that's really the the goal of a free gingival graft and this was my recommendation for this patient so this this patient asked me doc how much time do I have I'm planning a trip I don't really have the time to do anything right now I'll do it but now it's not a great time for not a good timing for me how much time do I have which you know we it's very hard very hard question to answer and what you'd like to tell your patient is you know this procedure needs to be done right now it's not an emergency they know there's no infection or any symptoms so your patients have the luxury of picking a good time for them on the schedule when they don't travel or have any significant events in their lives but they need to do it in a timely matter and I I pick a period of between two to four months they need to have it done so the interesting part of this case actually the patient actually made an appointment four weeks later to see me and in the next video I'm going to show you something very amazing that this patient presented with and we show you the consequence of no treatment so I hope you like this video I hope you found it interesting feel free to share it with other colleagues see me next week in part two of this video where I'll show you the big problem that I saw I'll see you next time you