Treatment of Deep Intrabony Defect with Buccal Gingival Recession using Connective Tissue Graft Combined with Enamel Matrix Derivative and Bone Graft: case reports

Abstract

It is a challenging situation for clinicians in managing deep non-contained intrabony de¬fects associated simultaneously with soft tissue recession nowadays. Besides, prevention of post-operative gingival recession is one of treatment goals for ideal regenerative surgery as well. The case reports tended to achieve periodontal regeneration and root coverage in teeth affected with both deep intrabony defects and the buccal gingival recession using the concept of connective tissue (CTG) wall technique combined with enamel matrix derivative (EMD) and bone graft materials. The surgeries involved a single flap approach (SFA) and augmentation of soft tissue, attempting to minimize post-operative gingival recession, by suturing the CTG on the inner surface of coronally advanced flap (CAF) as a barrier wall for the coronal portion of the bone defect. The bony defects were filled with allograft and/or xenograft as a space mak¬ing scaffold and followed by primary closure of wound. Significant probing depth (PD) reduc¬tion, clinical attachment level (CAL) gain and improvement in the level of gingiva margin were noticed after 7- and 11- months follow-up respectively. Comparisons of pre-operative and different periods of radiographic images demonstrated that the bone defects were indeed filled. It can be concluded that the CTG does support the bone regeneration and overlying soft tissue flap stability within the periods of observation. This surgical approach provides an alter-native aid on the clinical outcome of bone healing and root coverage simultaneously in deep intrabony defects.