Periodontal Regeneration in Esthetic Zone. Advice?

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Posted on By Valeria Zamberlin In Periodontics

Any advise is welcome! This 50 years old lady has a severe periodontal disease. HOW WOULD YOU MANAGE this central incisor (tooth#8)? It has probing depth 8mm mesial, 6mm vestibulo-mesial, 6 mm palatal mesial. There is no probing depth on the other aspects of the tooth or other anterior superior teeth.Now we are in basic periodontal therapy and hygiene. Esthetic demands are huge!

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GTR perio regeneration followed by ortho extrusion as needed to alter papilla height. Endo and crown may be required to maximize esthetics. But please also do not forget to diagnose the entire mouth which has several areas of acute periodontal breakdown. Dr. Salama


Hi, looks like she suffers from aggressive perio molars included ...
maybe consider treating the disease prior to symptoms. Good luck


Hi Valeria,

This is severe periodontitis without obvious inflammatory signs and symptoms, judging from your Pan.

It's a possibility there is an unexpectedly virulent bacteriological expression in the context of serious systemic conditions, such as hyperglycemia or some autoimmune manifestation.

This patient with a lovely smile is at the precipice of losing her lower front teeth as well as some molars.

Whatever the treatment plan is, it should include bacteriologic testing for periodontal pathogens. Actinobacillus actinomycetemcomitans, Treponema, P. Gingivalis, etc., are culprits to look for.

Perhaps even suggest a blood test. One-fourth of diabetes in North America is undiagnosed. Ten percent of the population are prediabetic. These hyperglycemic conditions are closely linked to severe periodontitis.

It's just possible this multi-profession approach to the diagnosis of periodontal disease will save lives, besides saving teeth.

Valeria, this patient needs help.

Best of luck,


John Chao, D.D.S.
Inventor of the Pinhole Surgical Technique
Research Associate Professor, Buffalo, SUNY
Adjunct Assistant Professor, USC


John; Thank you. So well said. This is a severe perio case that may have systemic manifestations well beyond the singular area of concern described here. This case should be seen by a periodontist for sure in my opinion. regards Dr. Salama