Periodontal reconstructive surgery with improved papilla architecture: Case report with 24 months of follow-up

Periodontal defect reconstruction often relies on bone or bone substitutes to fill defects, membranes to exclude tissues unsupportive of new bone and attachment, and biologics to stimulate cells for healing and tissue formation. The scaffold we used is a nonparticulate osteoconductive bone substitute for repairing defects without migration of particles and maintaining volume above the walls and confines of the periodontal treatment site. This may provide a more predictable option for rebuilding lost supporting bone, especially in less contained defects.

A case of periodontitis stage III grade A at tooth no. 5 treated with intentional defect overfill to sustain interdental papilla with filling of the defect. Established guided tissue regeneration techniques were used.

After 15 days, complete soft tissue closure at the defect site and root coverage at tooth 6 due to coronal advancement of the flap were observed. After 1 year, the papilla between teeth 6 and 5 filled the interproximal space, recession at 6 and 5 was 0 mm, and clinical attachment level gain at 5 was 4 mm. Soft-tissue maturation continued over 2 years, showing increasing thickness and healthy aspect. Over 24 months, increasingly defined bone-like imagery of the infrabony defect was obtained on X-ray without probing.

Using a cross-linked, completely resorbable collagen scaffold covered with a membrane based on the same engineering promoted tissue growth above the walls of the defect. This was effective in bone regeneration of an intrabony defect.

Why is this case new information? This is a case report describing the use of a completely resorbable ossifying collagen sponge with intentional overfill of the periodontal defect. This surgical technique allowed the clinician to improve the reduced interdental papilla architecture together with filling of the defect. This outcome represents a difficult and unpredictable goal for traditional periodontal reconstructive therapy. What are the keys to successful management of this case? Proper diagnosis and treatment planning Adequate and minimally invasive nonsurgical preoperative preparation of the soft tissues Graft trimming and proper adaptation Soft tissue management with mucogingival approach (split thickness papilla incision-flap elevation-sutures) What are the primary limitations to success in this case? Inadequate preoperative nonsurgical therapy Poor handling of soft tissue Inadequate graft shaping Strict adherence to pre- and postoperative oral hygiene and maintenance PLAIN LANGUAGE SUMMARY: Bone or bone substitutes can be used to rebuild lost supporting bone in dental repairs. A female patient at risk of tooth loss because of gum infection and with a gap between two of her teeth was surgically treated with an ossifying collagen sponge, covered by an ossifying collagen membrane. This ossifying collagen sponge can be shaped as needed. This allowed the clinician to intentionally overfill during the procedure to treat the patient. Surgery was successful, with the patient's condition and defects repaired. She did not experience infection, pain, swelling, or discomfort as a result of the treatment. This is a novel use of this ossifying collagen sponge substitute. More studies may confirm the suitability of the bone substitute used in this case more generally in similar dental repair procedures.