The purpose of this article was to discuss reverse gingival architecture on the buccal aspect of maxillary molar teeth and to introduce the palatal approach as a possible solution to this problem.
Normally, the interproximal bone is at a more coronal level than that on the buccal and lingual surfaces. The common interdental bone loss causes the reverse of this situation. As well, when osseous surgery is not performed according to its principles, reverse architecture can also be created. The presence of gingival architecture after osseous surgery results in recurrence of pocket depth.
Up to that date, the buccal approach was being used because of accessibility.
1) One of the serious problem with this approach is the increased risk of opening the buccal furcation in order to attain positive architecture.
2) Reversed architecture on the upper molar area is the development of a prominent, bulbous interradicular papilla.
3) The buccal bone on maxillary molars is very thin usually, with absence of cancellous bone. Fenestrations and dehiscences are not rare on this areas because of tooth rotation. Therefore, once bone is exposed, its resorption on buccal area is greater than in interproximal bone where cancellous bone is present. It will induce an accentuation of the interradicular papilla and assure an abnormal physiologic contour.
4) After surgery, as time goes, the gingival margin on the buccal side tends to become rolled and thick. The same fact does not take place on the palatal side.
5) If the buccal wall of the crater is removed, root proximity problems can be created between roots of two teeth.
Buccal wall reduction can, therefore, be performed to a certain extent, especially in medium and deep crater, but most of the reduction should be done from the palatal side. The bone on the palate is thicker and presents cancellous bone, which has good potential for osseous deposition after surgery as well as less bone resorption.
Visibility from the palatal is enough to perform this reduction.
The same rules do not apply for mandibular molars because of different anatomy.
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