Overview
Regenerative periodontal therapy aims to rebuild lost support tissues around compromised teeth, including cementum, periodontal ligament, and alveolar bone. In selected defects, combining enamel matrix derivative (EMD) with allograft can improve both hard- and soft-tissue outcomes.
Case Summary
- Patient: 27-year-old, healthy, non-smoker
- Main concern: advised elsewhere to extract tooth 31
- Findings: tooth 31 with mobility grade 2, probing depth up to 8 mm, bleeding on probing
- Radiographic finding: distal infrabony defect around tooth 31
- Diagnosis: localized periodontitis
Because of the location and defect pattern, extraction risked additional hard- and soft-tissue loss in a highly visible and functionally important area.
Why Regeneration Instead of Extraction
For this case, a preservation-first approach was chosen to maintain natural dentition and restore support around tooth 31. Regenerative surgery with EMD plus allograft was selected as the biologically appropriate option.
Surgical Protocol (Clinical Sequence)
- Tooth stabilization with splinting to adjacent teeth before surgery.
- Simplified papilla preservation flap from 33 to 43.
- Thorough debridement, scaling, and root planing.
- Root conditioning with preparation gel, then rinse and dry.
- EMD and allograft preparation.
- EMD application to root surface and graft placement in the infrabony component.
- Flap closure and suturing with nylon.
Early Healing Milestones
- Day 10: sutures removed
- First phase recommendation: avoid probing for 6 months
- Follow-up images demonstrated papilla closure, healthy soft-tissue contour, and radiographic bone fill trend at the distal aspect of tooth 31
Clinical Video
Key Clinical Point
When defect morphology and patient factors are favorable, regenerative therapy can shift the decision from extraction to preservation.
Try to save teeth before extracting them.
For consultation on periodontal regeneration planning, use the contact page.