Conservative treatment of deep pockets in the anterior zone with minimal post-treatment recession

In a highly aesthetic area, the ability to preserve the papilla and avoid “black triangles” post-treatment is the ideal outcome. However, with surgical and nonsurgical treatment, recession is commonly the inevitable result. The case below is an interesting result on what can be potentially achieved with periodontal endoscope and emdogain.

A 45 year old female was referred in April 2016 for treatment of localised aggressive periodontitis. There was no relevant medical history and the patient had no previous periodontal treatment. The 12 had the deepest pockets with 9-10mm on the mesial aspect.

A vertical defect was evident with loss of ~ 70% of bone on the mesial. Slight loss of papilla was evident clinically between the 11 and 12 prior to treatment. Standardised radiographs were taken using silicone rubber impression material.

The 12 was splinted to the adjacent teeth prior to treatment to provide stability, and the occlusion adjusted. The patient was treated using the perioscope  and emdogain applied to the mesial defect. Subsequently, the patient was placed on a regular supportive maintenance schedule and the 12 site not probed till 12 months later. At 12 months, the 12 showed radiographic bone fill and reduced probing depths of 4mm on the mesial without bleeding on probing. Most welcoming was the fact the papilla between the 11 and 12 appeared stable without the increase in the interdental space.

 Pre-op photo

Pre-op photo

 Post–op 12 months later – dentist placed restoration mesial 12

Post–op 12 months later – dentist placed restoration mesial 12

 Pre–op standardised radiograph (12 months later)

Pre–op standardised radiograph (12 months later)

 Post–op standardised radiograph (12 months later)

Post–op standardised radiograph (12 months later)