Periodontal regeneration in deep infrabony defects with CaP/ß-TCP and hyaluronic acid | PARADENT
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Case provided By Prof. Dr. Anton Friedman Orcid (Chair and Head Department of Periodontology, School of Dentistry, Faculty of Health, University of Witten, Germany)

Female 35 years non-smoking patient with two singular periodontal defects

Mandibular right first molar with progredient attachment loss and infrabony defects

Baseline assessment: intact papillae; narrow interdental space; no gingival recession

Initial PPD distal 7 mm; BoP+ Initial PPD distal 7 mm; BoP+
HYADENT BG clinical case
Initial PPD mesial 8 mm; BoP+ Initial PPD distal 8 mm; BoP+

Minimally invasive periodontal surgery

M-MIST flap design (Cortellini 2008); infrabony component treated with CaP/ß-TCP + hyaluronic acid (Osopia® + hyaDENT BG®, Regedent Germany)

Mesial 1- to 2-wall defect at 46 from the buccal and the lingual aspect
Mesial 1- to 2-wall defect at 46 from the buccal and the lingual aspect
Mesial 1- to 2-wall defect at 46 from the buccal and the lingual aspect
Distal 1- to 2-wall defect at 46 from the buccal Distal 1- to 2-wall defect at 46 from the buccal
Graft preparation by hydrating Osopia® with HA Graft preparation by hydrating Osopia® with HA

Flap closure and suture

Complete primary tensionless closure of interdental papillae using the CAF principle and modified matrass suture (Laurell et al., 1994)

Suture material: monocryl® 6.0 (Ethicon, Germany)

Buccal view Buccal view
Lingual view Lingual view

Post-op monitoring

Uneventful healing, suture removal at 2 weeks visit

Reported by the patient loss of some particulate material

One week post-op buccal/lingual view
One week post-op buccal/lingual view
One week post-op buccal/lingual view
Two weeks post-op buccal/lingual view
Two weeks post-op buccal/lingual view
Two weeks post-op buccal/lingual view

Evaluation of regenerative result 12 months post surgery

Clinical examination: no gingival recession; no loss of interdental papillae

Assessment of PPD and BoP tendency

One week post-op buccal/lingual view
One week post-op buccal/lingual view
One week post-op buccal/lingual view
Two weeks post-op buccal/lingual view
Two weeks post-op buccal/lingual view
Two weeks post-op buccal/lingual view

Radiographic assessment of treatment sequence

X-ray documented transition from bilateral deep infrabony defect towards complete defect resolution 1 year after surgery

Baseline periapical x-ray Baseline periapical x-ray
Post-op periapical control Post-op periapical control
1-year post-op control 1-year post-op control
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