Dmitriy Ivanov, DDS Board Certified Periodontist and Implant Specialist

11/10/2025

Palatal recession is not the most common to see but does come thru once in a while!

Gingival recession more typically occurs on the facial/buccal aspect, but recession on the palatal/lingual aspect can happen due to:
- Orthodontic tooth movement that positions the palatal roots or natural root position root being more palatally positioned.
- Periodontal disease affecting the palatal/lingual tissues,
though it’s less common than on the facial aspect.
- Mechanical trauma from habits or improper flossing/toothbrush technique against the palatal tissue.
- Thin gingival biotype and thin palatal mucosa around molars (also less common)
- Surgical or restorative procedures that disturb the palatal tissue or blood supply.

Associated symptoms (sensitivity, mobility, esthetic concerns).

Possible contributing factors (bruxism, brushing technique, plaque control, occlusion, orthodontic history).

Treatment requires a vascularized grafts due to inability to coronally position palatal flap leaving most of the graft across the root surface exposed (root surface is vascular).

VIP CTG in this case was still attached to the GP source of the blood supply!

PO 3 weeks and 3 months showing adequate root coverage and improved phenotype over then previously exposed root surface.

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🔔 Still looking gift the next soft tissue course ? Check out our soft tissue course in December in Texas !
Info on our website!
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11/06/2025

Another day another immediate 🥖 and 🧈

Challenging deep bite, so had to shorten the tooth a bit to make sure there was no excursive on the Invisalign edge.

Great lesson to take pics bc after placing and initial photo I saw that we were a bit shallow on placement which I almost didn’t see until I looked at the photo. That allowed me to place my implant slightly deeper to get me where I want to be 4mm below facial gingival zenith.

Pushed zenith and medial papilla with temp modification at 4mo to put the zenith to preop place.

✌️ happy Thursday everyone!

🔔 Don’t forgot to check out our last course of 2025 in Texas ! Will be epic along side and .amigos!

Info on our website!



Pt was sent to GP for restorative after 5 months

11/03/2025

Classic PerioProsth Immediate #8 A-Z with all the fixings!

Great stability is always the precursor to a great case

Top it off with a nice CTG and an excellent full contour temp to preserve and maintain soft tissue architecture in its natural form.

PRECISION Perio Implant!

Excellent Prosth and final prosthetic photos by amazing .stellastavrou

Happy Week yall !!!

09/12/2025

Autogenous Friday: root coverage on the roots covered by composites requires thorough removal of the composite material and clean out of the root!

I like to use a diamond football bur to do that followed by either a back action or scalers to finish

Making sure to round off the coronal edge of the prep.

CTG taken by dFGG and stabilize with 6.0 proline interrupted slings

Modified split thickness vista is used to manage muscle internally

Healing after 2 months solid coverage , phenotype enhancement and gain in AG!

Happy weekend y’all and don’t forget to check out a couple of soft tissue grafting courses in Texas , LA and DC this and next year that are open for registration on our website: www.perioamigos.com

09/03/2025

Immediate Kinda Hump Day!

Bread 🍞 and butter 🧈 workflow with immediate placement, connective tissue graft and immediate provisional.

Vertical Roof Fracture , non restorable tooth 🦷

Careful removable and immediate placed with high insertion torque, bone grafted in the jump gap (cc allograft)

Provisional: I love the shape of temp abutment emergence and ability to select heights of where restorative margin will start is so money Blue Diamond 💎 Implant!

CTG to ensure soft tissue stability long term.

Temp Shell 🐚 premade by the lab as usual milled PMMA with indexing wings 🪽

Final restorative in 4 months post placement!

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09/02/2025

Nothing is better than spending Summer with Friends and Family! Cheers and till Next one!

Fall and Winter is going to be even more busy !

Two more courses left for the year with .amigos , register now !

08/31/2025

Treating Lichen Planus using a Connective Tissue Graft!

I had also done this with FGG which works beautifully also!

Palate is the gold standard for soft tissue recon even in these chronic diseases.

Modified 3mm hole along with a nice piece of CTG is all here! Good muscle management using the split thickness approach is fantastic deepening the vestibule and allowing increase in attachment as well as no tension advancement.

Want to learn more about treatment of teeth or dental implants with recession? Check out one of our courses this and next year!

We got one in Texas and One in Los Angeles coming up! Register www.perioamigos.com with .amigos and .perio

08/02/2025

Gold Tooth alert 🚨 Have You Seen and Implant Gold Tooth!

Not something we get to see daily implant practice but what a fun surprise when patient came back for 1.5 year follow up post implant management.

Patient came in post 1 year since last visit , while covering his face and goes : hey doc are you ready to see what’s going on ? Here I’m thinking there is a problem with my implant I did a year and a half! But to my pleasant and shocking surprise….i got a gold tooth doc! Amazing 🤩

Previous implant had failed after 10+ years in function! Thankfully we don’t place wider diameter implants in the esthetic zone much :) why? Well narrow diameter = more buccal bone to maintain our tissue!

Whats a good size for a central ? 3.3, 3.7 would be my picks in general , and if the ridge is huge I would go with 4.0,4.1 but that’s all !

Case was managed with staged Hard and then soft tissue rebuild ! Always auto for the CTG!

Amazing restorative management by the master himself

Patient loves his final restorative which completes his persona perfectly!
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🔔 Interested in learning Hard or Soft Tissue management ? Take one of our upcoming courses on our website perioamigos.com or thru link on my Profile above ☝️
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08/02/2025

07/11/2025

Complex cases require many stages and some fine tuning alongside patients commitment and compliance!

Started case with hard and soft tissue rebuild ans subsequent implant placement with more soft tissue added!

I love the use of VIP CTG for these cases where we have a need for vertical height and/or papilla reconstruction.

Amazing orthotics by who diligently worked with me to dial in not just adequate spacing but also aesthetics of the case at the end!

Provisional phase of treatment was crucial to dial in the spacing as well as the zenith of the lateral Pontic site to closely match the contralateral tooth #10.

Provisional and Final restoration Zirconia with anodized gold abut by one and only LAB guy who knows his stuff well

Happy weekend ahead!

🔔 Come learn Bone and tissue Management techniques in many of our courses this and next year! Check our website for more information! Link in profile above ☝️ or perioamigos.com
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06/30/2025

There are usually not many complications associated with the use of autogenous , although sometimes we may need to address challenges ourselves.

Some possible complications include:
- Incomplete root coverage
- Infection
- Bleeding from the palate
- Significant pain beyond the norm due to early loss of palatal protection
- Suture tips poking the lip, which may cause painful aphthous-like ulcerations on the mucosa lining the lip

Management is always best achieved through prevention or by setting appropriate expectations for these issues whenever possible.

However, even with best practices, we may still need to manage one or more of the above complications.

In this case 👆, it appears that a small amount of composite was left on the root surface during preparation, blending closely with the root shade. The tissue never reattached to that biologically incompatible root surface.

Another important aspect of management is applying different techniques when needed—for example, a coronally repositioned flap to treat a single tooth without extending the flap to sites previously treated with connective tissue grafts (CTG).

No graft was added during the second surgery because the preexisting CTG had already integrated with the tissue of #11, allowing us to simply reposition the tissue coronally.

The CAF was performed according to the Zuchelli Split Full Split protocol and stabilized with a sling suture.

One month post-op, healing was excellent, and we anticipate a beautiful maturation of all sites moving forward.
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3 NEW 🥵 🔥 soft tissue management only courses Added on our website!!! December 2025 , April and August 2026! Make sure to check it out and grab your seats while we have early birds!! They will sell out!
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06/02/2025

Monday funday with our fave area : anterior mandible root coverage in the presence of proximal attachment loss.

This area is so perfect to manage with a modified 3mmhole technique (VISTA) bc it allows us to predictably manage the muscle position 💪 and create a better tension free tissue to advance.

CTG is always best option here to gain us excellent thickness, perfect attached tissue (functional mucosa) and deeper vestibule.

Healing after 2 months ✌️
amigos 3 Day Tissue course is in a few weeks in SF , few spots still available! Register on our website !