Severe interproximal bone loss in the anterior maxilla poses more than one challenge. Tooth preservation being one, and aesthetics being the other.
This case demonstrates that challenging issue.
This case involves a patient who presented with very deep pocketing between teeth #7 and #8. The teeth both tested vital. The pocket, as exemplified by this x-ray and photograph, represents the loss of interproximal bone. Due to the proximity of the roots, complete regeneration of this defect and preservation of both teeth, as well as maintaining a satisfactory aesthetic result is difficult, if not impossible.
It was elected to remove the more severely of the two teeth. The preservation of the other incisor would more likely result in a regeneration of some of the interproximal tissue.
As you can see from the photograph, the defect was substantial, involving the central incisor, after tooth removal.
Because the defect at this point was a three wall defect, there was more likelihood that bone regeneration could take place on the mesial aspect of the remaining tooth.
A bone graft was done, covered by a membrane; bone regeneration did occur.
At that point an implant could be placed
and as is visualized on this picture bone regeneration had occurred on the mesial aspect of the central incisor, both clinically and radiographically. Had the other tooth been removed as well, the degree of bone regeneration would have been unlikely, if possible at all.
As always, I appreciate your feedback.
Victor M. Sternberg, D.M.D.
By Westchester Center for Periodontal & Implant Excellence
January 12, 2023