Phase I: Diagnostic Wax-up
Photographs, panoramic and full mouth intraoral radiographs, diagnostic casts mounted in CR (centric relation), and clinical and periodontal chartings were obtained.
Phase II: Periodontal Treatment
Overall periodontal health would be improved with root planing, scaling and oral hygiene review.
Phase III: Regenerative Surgery
To correct defects around teeth nos. 7 and 8, regenerative surgery was performed using a PTFE-e membrane (GORE-TEXÒ Regenerative Membrane Titanium Reinforced) fixed with two tacks and PTFE sutures. The biomaterial used consisted of autogenous bone harvested from the oblique line of the mandible. The periodontal defect was thoroughly cleaned, reaching almost the apex of tooth no. 8. A connective tissue graft was harvested from the palate and sutured on the buccal and proximal of tooth no. 8 to correct the gingival recession which appeared after the scaling. The PTFE-e membrane and the tacks were removed approximately one year later. During the second surgery, a fistula was detected on the buccal area of the regenerated bone. Tooth no. 8 was diagnosed as necrotic, and endodontic treatment was immediately performed. An additional connective tissue graft was harvested from the palate to compensate for the lack of volume due to buccal bone resorption caused by the fistula.