Regenerative Measures for Osseous Defect Repair and Optimal Esthetics

Procedure
Theoretical Part

• Adult male with a deep and broad intraosseous bone defect located on tooth #13
• The indication for modified papilla preservation in the scope of regenerative therapy was established based on the width of the diastema
• Regenerative periodontal therapy with Emdogain and a Bio-Oss® cancellous bone graft
• Emdogain is applied to the root surface to stimulate regeneration of periodontal structures
• To prevent graft collapse and to minimize the risk of development of too large a recession in this esthetically important region, the defect was filled with Bio-Oss® cancellous bone material

Practical Part

• The papilla preservation technique was performed using microsurgical instruments
• The root surface area was conditioned with 24% EDTA for ca. 2 minutes
• Emdogain was applied to the root surface
• The defect was filled with the Emdogain/Bio-Oss® mixture
• The wound was closed with two mattress sutures one horizontal mattress suture to secure the graft in place, and a second modified vertical mattress suture to tightly close the papilla
• A 5-0 suture was used for the horizontal mattress suture, and a 6-0 monofilament was used for the vertical mattress suture
• Postoperative care entailed rinsing the wound twice daily for 4 weeks with 0.2% chlorhexidine and ibuprofen analgesia on the first few days after surgery

Contents
The patient's jaw displayed a generalized loss of clinical attachment and alveolar bone. His general history was unremarkable; the patient was a non-smoker. Microbiological tests showed large numbers of Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis. The diagnosis was "generalized aggressive periodontitis". After four months of initial therapy consisting of antibiotic combination therapy (amoxicillin + metronidazole), intraoral radiographs showed a deep and wide intraosseous bone defect located mesial and palatal to tooth #13. To preserve this strategically important tooth we opted to perform regenerative therapy with Emdogain and Bio-Oss cancellous bone material. Ten months after regenerative periodontal therapy, the probing depth had decreased by 7 mm, and 5-6 mm of clinical attachment had been gained. At this time, the probing depth was 2-3 mm and intraoral radiographs showed near-complete filling of the osseous defect.