Retained Primary Tooth Defect

105 Rating(s).

Posted on By Ben Lashley In Bone Grafting

16 year old female presented as referral from Orthodontist for removal of retained tooth letter A. Upon access, much puss and exudate was present as well as buccal bone dehiscence, and no alveolar tissue on either the mesial root of 3 or the distal root of 4. after removal of ankylosed A an oral antral communication was delt with by placing a collagen membrane over the communication. No bone graft was placed in the site as it was essentially a one wall defect. A collagen barrier membrane was placed in hopes for closure of the soft tissue. Now 6 weeks post op pt is still catching food and debris in what is a deep interpoximal defect. Debridement and waiting has been the treatment of choice but not sure when to go back in for soft or hard tissue augmentation. Any suggestions on how to best manage the case going forward would be greatly appreciated.

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This is not an every-day situation, but may be all together we could find a solution.
I wouldn`t rush with the second surgery but wait 3-4 months to see if some defect fill occurs.
If not - what about orthodontic solution? Moving the first premolar on the place of the second premolar and the second and third molar towards mesially?
It would require two teeth ex at very young patient...for this reason I would wait 3-4 months. If there is improvement, soft and hard tissue grafting may be considered.
Maurice and Henry Salama can elaborate this case from both surgical and ortho aspect, I am looking forward to see their comments.
Anyway, keep us posted!
Thank you for sharing


Did you check the vitality of the teeth before and/or after extraction?


If not better after a few months, you could try a Laser assisted new attachment procedure (LANAP) as to stimulate reattachment on the roots.


Any PA radiographs or CBCT sections? I do not like the mesial exposure on 1st molar or distal of premolar?? Strange appearance of this type lesion in such a young patient. I would prefer to wait several months as long as no issues regarding oral-antral closure.
Then CBCT and probe areas to see if there remains deep probing sites? Check occlusion and mobility patterns.
Only then would I consider surgical GTR with Emdogain and BG.
I remain hopeful that some significant healing potential remains here...
Keep us posted. Dr. Salama


Yes, I have pre-op CBCT but nothing post as it has only been 8 weeks. My concerns were also lack of blood supply and angiogenesis with placing anything but blood products. I did place two PRF clots when closing and I am confident we do not have oral antral communication right now due to lack of air exchange. I plan on waiting 3-4 months as suggested with seeing her once a month. I also am having her irrigate with peroxyl twice a day and especially before bed to keep it clean as possible for regeneration. I did not test vitality of the two teeth but will in the future. Thanks so much for the input and I will keep you posted. Meantime, if you think of anything else to try let me know.



Update: It has been now been 5 months since first surgery. The patients oral hygiene is not superior but we have achieved a re-growth of soft tissue at least. There is clearly still a defect but the palatal tissue has grown to what I would call normal papilla height. The buccal has a defect clearly but clinically you can see the base of it about 6 mm apical of the CEJ. There is still a bony defect of unknown depth due to PA and probing. Clear root surface exposure is evident on the distal of 4 and the mesial of 3 The question is what now. I think I could achieve primary closure over a bone graft with a CT augmentation but not sure the predictability of bone gain on root surfaces that have been exposed for this long and really have no buccal or possibly palatal walls to the defect. It is sort of like a zero wall defect. Advice is welcomed.