WWYD-defect grafting in the anterior

145 Rating(s).


Posted on By michael melkers In Periodontics

I am curious how the eXPerts might approach the grafting for this case.

This is a new patient that we are working up a restorative plan on but he presented with a fistula apical to the gingival margin of #8/11.

Tooth tests vital

CBCT at endodontist shows no apical communication, no fracture

Patient has no pain and aside from knowing the fistula is there, he has no awareness due to any symptoms.

I entered in an exploratory fashion and derided the area but did not graft. I am re-entering next week. Healing at suture removal looked good. 6 week post op showed the fistula returning.

There was some discussion of a possible cemental tear but I did not stain at the initial surgery...but will this coming week.

cortical/cancellous?
Dual zone?
Xeno only?

Thanks in advance for the help and input.

Initial entry
Pre-op radiograph.

2 week post op
6 week post op
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3 Comments

Mike, don't claim to be an Xpert, but is there a history of trauma? The PA sure looks like an oblique fracture. Any perio pockets associated with the fistula, maybe on the mesiolingual?? Thanks for the post.

Fractures


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Mike, even after removal of granulation tissue in the first attempt, its coming back, that says there is a source of infection, and that could be due to various reasons. In such cases before reentering with grafting plan, i prefer doing Intentional Endo first and observe. Got good results. Regards.


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