Treatment of a premolar periodontal defect in the furcation area

The Situation

A 46-year-old patient presents with generalized periodontitis in stage 2, grade B. Tooth 15 is missing. Secondary migrations in the maxillary anterior region have been appearing for several months. After initial periodontal therapy, pockets of more than 6 mm with bleeding upon probing persist on teeth 25, 42 and 43. Regenerative surgeries for both sites are scheduled.
A periodontal regeneration technique is applied to treat the infra-osseous lesion present mesially and palatally on tooth 25.

The Approach

An exclusively palatal full-thickness flap is prepared from the distal side of tooth 26 to the mesial side of tooth 24, taking care to preserve the papillae. A palatal relief incision of 3 mm is made on the mesial side tooth 24, taking care to preserve the papillae. A palatal relief incision of 3 mm is made on the mesial side of tooth 24. After debridement of the granulation tissue and careful exposure of the intraosseous lesion, a mixture of Geistlich Bio-Oss^® and REGENFAST^® is placed in the bone defect, without a membrane. Vertical mattress sutures are placed in the interdental spaces.

The Outcome

The aim of the treatment is to reduce the pocket depth. The favorable morphology of the bone defect makes it possible to reduce the pocket depth using a tissue regeneration technique. The use of a bone xenograft allows creating a matrix that promotes osseous colonization of the defect from the bone margins of the defect. Its combination with REGENFAST^® is designed to potentiate this osteoconductive phenomenon and accelerate mucosal healing.

Keys to Success

• Effective initial therapy
• Excellent plaque control
• Management of risk factors
• Suitable morphology of the bone defect
• Minimum flap management with papilla preservation