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06 February 2019

Surgical treatment in a patient with severe chronic periodontitis - a clinical case

Maria Di Martino

A woman of 34 years in 2013 presented to our attention for a chronic localized severe periodontitis at the level of incisors 1.1-1.2.
Clinically, between the two elements, a deep crater-type infraosseous defect was found, extended over two-thirds of the root length of both dental elements. It was the result of an inflammatory process intercepted by her orthodontist about 10 years and never treated with any therapy.
The prognosis of the elements is doubtful. The aesthetics of the smile is compromised both by the presence of a negative papilla and by an important vestibular recession of the two incisors (fig 1-2).

  • <p>Figure 1: at the beginning of the therapy</p>

    Figure 1: at the beginning of the therapy

  • <p>Figure 2: at the beginning of the therapy</p>

    Figure 2: at the beginning of the therapy

The initial therapy provided for a careful and selective non-surgical treatment in order to reduce the inflammation of the periodontal tissues and prepare them for a regenerative therapy of the site 1.1-1.2 .
The latter provided for: simplified papilla preservation (SPP) incision, regeneration with the use of amenogenins combined with xenograft, coronal flap displacement thanks to a periosteal release in order to guarantee a primary interproximal closure and reduce recessions as much as possible vestibular of the two elements.
This therapy was a success, as it resulted in a reduction of probing depth of 7-8 mm and no bleeding.
After stabilizing the regenerative therapy results and the state of health of the two incisors, the second surgical phase aimed at improving the aesthetics with a bone-resective therapy for gingival smile correction and a modified tunnel technique for the increase of volume of the papilla 1.1-1.2. 
The result at 5 years from the beginning of the treatment shows a stable state of health of the incisors in question with physiological periodontal parameters and an aesthetically pleasing smile with a high degree of patient satisfaction (fig. 3-4) 

  • Figure 3: the result at 5 years from the beginning of the treatment.

    Figure 3: the result at 5 years from the beginning of the treatment.

  • Figure 4: the result at 5 years from the beginning of the treatment.

    Figure 4: the result at 5 years from the beginning of the treatment.

This clinical case has highlighted the importance of an accurate diagnosis that takes into account the entire oral cavity in the dental and periodontal plane and a biologically driven therapeutic approach aimed at exploiting as much as possible the reparative and regenerative potential of tissues in a patient with optimal compliance.

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Authors: D. Migliari, N. Sugaya, M. Trieveiler.

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