GTR or extraction of periodontally involved tooth?

316 Rating(s).

Posted on By Maurice Salama In Periodontics

A patient presents to the office in need of implants. An adjacent premolar tooth displays significant pocket depth and bleeding upon probing. Preop radiograph shows some moderate bone loss and clinical pic confirms the periodontal lesion present. Thoughts on extraction, GTR and save tooth or?? I decided to SAVE the tooth and the same time as implant placement. Dr. Salama

Intra operative view after debidement
PA preop

Guided Sx
Bone Graft and PRF

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PA pre and post GTR....Dr. S

PA preop
PA at 5 months


Mo. Great case!!!! First class Periodontics in an implant world it seems we live in. A lost art form rediscovered. Well done! Best wishes. Chuck


Thanks Chuck....god old fashioned GBR PDL mediated regeneration with PRGF, 50:50 BG, collagen membrane (Xmphony drapeable membrane from Salvin)...interestingly, we got nice regen on mesial of molar and buccal aspects of implant sites. regards Mo


As a side issue, crestal sinus bump performed here on distal implant site with Versah Densah OD drilling protocol. Note radiograph at 5 months showing good calcification of bone above implant. regards Dr. Salama


Great results. I too would have opted to save the tooth through GTR, however I'm a little risk averse in cases like these and would have likely staged tx, with GTR first to regenerate the bone around the tooth, then place the two implants in a stable site. Incredible regeneration shown here. What was the graft material; allograft, PRF.... any autogenous bone used from the osteotomy sites?? Did you use any membrane at all? What do you think may have been the etiology of the bone loss. I would have initially though a root fracture based on the bone loss and existing post, however your results prove otherwise. Nice case and beautiful results. Regards, Naheed


Naheed; Yes, a root fracture was considered but no symptomology or fracture found, this was classic perio lesion possibly enhanced by occlusal trauma. We used GBR PDL mediated regeneration with PRGF, some autologous and 50:50 BG mineralized irradiated small particle allograft, collagen membrane (Xmphony drapeable membrane from Salvin). regards Dr. S


Fantastic results Maurice!

I too would have approached the case similarly. In my opinion, you can always remove the tooth if it doesn't respond to our treatments. At the very least it would have supported the provisional during healing. Did you make any adjustments to the premolar aspect of the provisional so as not to have to much trauma during healing?

How similar is the Xmphony membrane to Biogide? I have recently returned to using Biogide because of its drapability. I also still use GenOss collagen membrane (Dentium) when I want a more rigid membrane.

Thanks. Speak soon.



Mark; Thank you....brings us back to PENN PERIO days. Yes, adjusted occlusion, thorough debridement of well contained defect with multiple walls.
Yes, Xmphony is an EXCELLENT product IMHO and very similar to Biogide's drapeability and with better tensile strength. Salvin's Oramem Sustain is my go to rigid collagen barrier....but there are many that fit the bill. warmest regards my friend, Mo


Dr. Salama,

outstanding result, the tooth is saved and implants are happy and safe!
Like Naheed, I would have staged the therapy, with GTR first then implant placement in a stable site, although 3-wall defects respond rather predictable to GTR plus occlusion adjustment.
Thank you for sharing!


Thanks Snjezana, that was point of this post as most new clinicians would simply extract this tooth....Dr. S


Mo this is an uncommon case: first of all at the initial bone looks like expanded. A very strange lesion. Well managed! Nice decision tree to learn about. This is experience is all about.
After, the regeneration was successfull! Good choice of materials and technique.
My compliments. Perfect treatment.



Just a beauty- will you splint the implants and what are your thoughts about the regen premolar now that it will be free standing after restoration of implants




Richard....I'm feeling good about these supporting themselves individually....regards Mo


Awesome regeneration !!



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