Minimum flap management with papilla preservation

Periodontal treatment

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Dr. Philippe Doucet

Treatment of a periodontal defect in the furcation of the maxillary premolar with Regenfast® and Geistlich Bio-Oss®

The clinical 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.

Risk profile Low risk

Intermediate risk

High risk

Patient’s health

Intact immune system (non-smoker)

Occasional smoker

I mpaired immune system (heavy smoker)

Patient’s aesthetic requirements

Low

Moderate

High

Smile line

Low

Intermediate

High

Gingival biotype

Thick – slightly scalloped

Moderately thick – moderately scalloped

Thin – strongly scalloped

Shape of the dental crowns

Rectangular

Oval

Triangular

Infection at tooth site

None

Chronic

Acute

Bone height at adjacent tooth

≤ 5 mm from contact point

5.5 – 6.5 mm from contact point

≥ 7 mm from contact point

Restorative status of adjacent tooth Intact Width of tooth gap

1 tooth (≤ 7 mm)

Soft-tissue anatomy

Intact

Bone anatomy of the alveolar ridge

No defect

Compromised 1 tooth (≥ 7 mm)

2 teeth or more Compromised

Horizontal defect

Vertical defect

Dr. Philippe Doucet • Diploma in Dental Surgery, Université Paris Descartes, 2004 • Master’s degree in osteoarticular and craniofacial biology, 2005 • University diploma in pre-implant surgery, 2009 • University hospital assistant, then consultant in periodontology at Université Paris Descartes since 2009 • Former editor-in-chief of Titane magazine • Participation in the establishment of the non-profit organization ParoSphère, which provides the general public with information on periodontal disease • Co-founder of ParoSphère Formation, a periodontology training organization

Testimonial “I decided to use Regenfast® in periodontal regeneration because its components – hyaluronic acid and polynucleotides – have interesting properties in various tissue regeneration procedures. Above all, I particularly appreciate the ability of the product to promote wound healing, which is pivotal in periodontal regeneration.”

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The therapeutic approach

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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 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 membrane. Vertical mattress sutures are placed in the interdental spaces.

The final result

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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.

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| 1 Pre-operative clinical aspect of tooth 25, palatal view. | 2 Pre-operative palatal view of tooth 25. A probing depth of 6 mm is present, with associated bleeding. | 3 Preoperative radiography: A radiolucent zone is visible mesially on tooth 25, at the furcation level. | 4 Full-thickness flap with mesial palatal relief incision of 3 mm and papilla preservation. Debridement of the lesion and exposure of the intra-osseous defect reaching the furcation zone. | 5 The papilla at the level of the defect is preserved in its entirety. | 6 Treatment of the defect with a mixture of Geistlich Bio-Oss® and Regenfast®. | 7 Vertical mattress sutures at the papilla level and O-sutures at the level of the relief incision. | 8 Suture removal 15 days after surgery. | 9 Clinical aspect after 6 months, vestibular view. | 10 Clinical aspect after 6 months, palatal view. | 11 Retroalveolar radiography 6 months after surgery.

Keys to Success More details about our distribution partners: www.geistlich-dental.com Manufacturer Geistlich Pharma AG Business Unit Dental Bahnhofstrasse 40 6110 Wolhusen, Switzerland Phone +41 41 492 55 55 Fax +41 41 492 56 39 www.geistlich-dental.com Affiliate Australia and New Zealand Geistlich Pharma Australia and New Zealand The Zenith – Tower A Level 19, Suite 19.01 821 Pacific Highway NSW 2067 Chatswood, Australia Phone +61 1800 776 326 Fax +61 1800 709 698 info@geistlich.com.au www.geistlich.com.au Affiliate Great Britain and Ireland Geistlich Sons Limited 1st Floor, Thorley House Bailey Lane Manchester Airport Manchester M90 4AB, Great Britain Phone +44 161 490 2038 Fax +44 161 498 6988 info@geistlich.co.uk www.geistlich.co.uk

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

After 6 months, the use of Geistlich Bio-Oss® and Regenfast® was found to have effectively addressed the intra-osseous defect at tooth 25 and improved the clinical parameters (pocket depth and inflammation).

Dr. Philippe Doucet

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