Guided Tissue Regeneration in a Left second Incisor with simplified Papilla Preservation.



Performed by: Dr Daniele Bordonali






Abstract: The Patient, V.M. female age 35 came to my attention for pain and swelling on the left second incisor.
A 12 mm probing on the palatal side was found, at pulp vitality test the tooth was still vital.

5 days amoxicillin were prescribed, then the first treatment option was guided tissue regeneration surgery because the lesion was mainly a periodontal one.

the main cause was the groove on the palatal side of the tooth starting from cementum enamel junction till the apex: this kind of groove is usually a way for bacteria that can lead to big bone loss.

a simplified papilla preservation technique from the palatal side was performed, then debridement of the defect, root planing, chemical decontamination with tetracycline was performed.

then after etching the coronal part of the groove a special material (ger store self-adhesive, resin-modified glass ionomer ) was placed to change the shape of the groove to avoid future bacterial contamination from that way.

a hydroxyapatite bovine bone was placed in the 3 wall bone defect without membrane.
single sutures were placed and only one mattress suture on papilla of the defect.


# 1 Baseline the tip of papilla well represented



#2 Palatal baseline






#3 Probing





#4 The groove




#5 Granulation tissue inside the defect





#6 Papilla preservation





#7  Bone defect after debridement




#8  Etching




#9  Root after restoration and root planning




#10 Biomaterial in place




#11  Suture




#12 Suture removal




#13 Healing 10 days




#14  20 days healing




#15  20 days good papilla healing




#16 Before/after papilla’s surgery




#17 20 days healing




#18 6 months check-up



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