Orthodontic movement into bone defects augmented with bovine bone mineral and fibrin sealer: a reentry case report

Periodontal disease can lead to migration of anterior teeth with the presence of infrabony defects. This creates the opportunity for treating such patients with a combined orthodontic-periodontic treatment. In the presented clinical case, an adult periodontal patient with extrusion of the maxillary central incisors and an infrabony defect on their lingual aspects was treated. During the surgical procedure, the bone defects were augmented with a combination of porous bovine bone mineral (Bio-Oss) and a fibrin-fibronectin sealing system (Tissucol). Ten days after surgery, the active orthodontic treatment started, and the teeth were intruded and realigned, moving the roots into the defects. After 6 months, the orthodontic appliances were removed and the teeth were retained by means of a resin-bonded splint. At this time, reduction in probing pocket depth and gingival recession was detected. Twelve months after the initial surgery, a reentry procedure was performed, showing complete filling of the predisposing defects with the presence of bone-like hard tissue. These clinical results suggest that teeth can be successfully moved and intruded into bone defects previously augmented with bovine bone substitute and fibrin glue. During the orthodontic treatment, this combined augmentation material was able to be replaced by bone-like hard tissue. At the end of the therapy, an improvement in esthetics and periodontal health status was registered.