Dr. Rodrigo González Terrats

Description:

A 50-year-old patient presented with advanced localized periodontal destruction at teeth 31 and 33, characterized by deep probing depths (10–12 mm), bleeding, suppuration, and increased tooth mobility. Tooth 31 was diagnosed with pulp necrosis and symptomatic apical periodontitis associated with a combined endo-periodontal lesion.

Comprehensive initial therapy included occlusal adjustment, splinting, meticulous subgingival debridement, and root canal treatment of tooth 31. At 6-week re-evaluation, despite improved oral hygiene, residual deep defects persisted, confirming the indication for regenerative intervention.

A minimally invasive surgical approach was performed, ensuring optimal preservation of soft tissues. Following thorough defect debridement and root surface conditioning, periodontal regeneration was achieved using a combination of enamel matrix derivative and cerabone^®+ HyA, selected for its excellent volume stability, handling properties, and osteoconductive potential. The graft was protected with Jason^® membrane, providing reliable barrier function and supporting guided tissue regeneration. Careful flap management and precise suturing enabled stable primary closure.

The treatment resulted in remarkable clinical and radiographic outcomes. After 1.5 years, probing depths were significantly reduced to 3–4 mm, with a clinical attachment gain of 6–7 mm. Radiographic evaluation demonstrated complete defect fill and apical remineralization, resulting in stable, inflammation-free tissues and a highly favourable long-term prognosis. Importantly, the 2.5-year follow-up confirmed the stability of the regenerative outcome, with maintenance of the regenerated bone volume.