Guided Tissue Regeneration in the Esthetic Zone of a 34-Year-Old Male
A 34-year-old healthy male presented with increased spacing between maxillary left central and lateral incisors. Clinical examination showed deep probing depths between #9-10 area. Cone-beam computed tomography (CBCT) showed vertical bone loss #9-10 wrapping around the palatal surfaces. Treatment recommendation included guided tissue regeneration (GTR) to stabilize the periodontium.
Area #9-10 was debrided and showed a wide 1-2 wall defect measuring ~7mm vertical bone loss. GTR procedure using Geistlich vallomix™ bone graft (allograft + xenograft) and a collagen membrane were employed and primary closure obtained. Healing at 2 and 4 weeks and 6 months showed proper bone fill with stable periodontium.
THE RISK PROFILE
|Intact immune system
|Impaired immune system
|Patient’s esthetic requirements
|Height of smile line
|Thick – “low scalloped”
|Medium – “medium scalloped”
|Thin – “high scalloped”
|Shape of dental crowns
|Infection at implant sight
|Bone height at adjacent tooth site
|≤ 5 mm from contact point
|5.5 – 6.5 mm from contact point
|≥ 7 mm from contact point
|Restorative status of adjacent tooth
|Width of tooth gap
|1 tooth (≥ 7 mm)
|1 tooth (≤ 7 mm)
|2 teeth or more
|Bone anatomy of the alveolar ridge
Correct the vertical bone loss around #9-10 and save the dentition. Sulcular incisions with a paracrestal incision around #9-10 were performed. The area was debrided showing a wide 1-2 bony wall defect (measuring ~7mm vertical bone loss). Primary closure was obtained using 6-0 prolene sutures.
The use of a minimally invasive surgical GTR approach showed excellent radiographic bone fill and reduction in probing depths from 8mm to 3mm at 6 months follow-up. Treatment outcome revealed stable periodontium and the patient was happy with the healthy stable teeth.
Guided tissue regeneration using Geistlich vallomix™ bone graft (allograft as an internal first layer and xenograft as an outside second layer) and collagen membrane showed predictable periodontal regeneration.”Dr. Bassam Kinaia
Understanding the biology of Geistlich vallomix™ to layer the allograft first (internally for better osteogenic potential) and xenograft second (externally due to slower resorption rate) allowed better space maintenance and predictable regeneration.”Dr. Bassam Kinaia
Bassam Kinaia, DDS, MS, DICOI
Dr. Kinaia is the Associate Director of the Graduate Periodontology Program at the University of Detroit Mercy (UDM). He is also the former Director of the Periodontology Program at UDM in Michigan and Boston University Institute for Dental Research and Education in Dubai. He is a Diplomate of the American Acade- my of Periodontology (AAP) and International Congress of Oral Implantology (ICOI). He received a certificate of Excellence from the AAP in recognition of teaching-research fellowship.