42-year-old male, systemically healthy, nonsmoker patient with generalized severe chronic periodontitis. Perio-endo lesions on teeth 13, 19 and 29.
Treatment procedures
Oral hygiene instructions, scaling and root planing. Endodontic treatment to the devital teeth 13, 19, and 29 at least 3 months before surgeries. Following this, free gingival grafts (FGG) were placed at the insufficient keratinized tissue zones (tooth numbers 19-20 and 29-30) before the regenerative surgeries.
Perio: Considerations of Free gingival grafts. Cost?
The flap surgeries were performed in two separate sessions as for maxilla and mandible. Enamel matrix derivatives (EMD) in gel form (Emdogain®, Straumann) and bovine-derived xenograft (BDX) (BioOss®, Geistlich) combination was used for the treatment of intrabony defects. For postoperative care the patient received amoxicillin + potassium clavulanate twice a day for 7 days, naproxen sodium, twice a day for 7 days and 0.12% chlorhexidine + benzydamine hydrochloride mouth rinse, twice a day for 4 weeks. Mechanical tooth cleaning was not allowed in the surgical area for the first 4 postoperative weeks. Sutures were removed at 14 days following the surgery. Patient was put on strict recall visits (every 2nd week during the first 2 months postoperatively and once a month for the 1-year observation period). Supportive periodontal treatment was carried out with 4–6 months intervals after 1-year. At the end of 7-year follow-up period, extraction of 14 was decided due to increased mobility and extracted tooth crown was splinted to the related region by the use of a fiber adhesive system.
Besides the regenerative procedures, two different periodontal techniques were also implemented in the mandible during the operation. One of them was root resection on tooth #31 at which a fracture was detected on the mesiobuccal root. The other application was the tunnel preparation instead of the indicated root resection on tooth 19.
Treatment outcomes
Postoperative healing was uneventful after both surgical sessions. At 12 months, there were considerable clinical and radiographic improvements in all parameters.
Any thoughts? vs Extractions?