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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.

• 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.

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.

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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.

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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.