anterior bone loss/perio plastic surgery

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Posted on By daniel gremban In Periodontics

Gwen is a 66 year old that had the anterior restored approx 10 years ago. 7 and 10 are individual crowns and 8-9 are splinted. According to Gwen the porcelain at the gingival level was originally pink but fairly rapidly became white.(surface stained?) 7 will eventually need to have an implant placed. Concern is in the replacement of 8-9. Can this defect be successfully bone grafted? Can we then improve the periodontal esthetics with periodontal plastic surgery? Splinted crowns are most likely the answer for 8-9 long term. Are we better off planning a redo of the case using impregnated pink porcelain?

bone defect
porcelain gingiva 8--9

porcelain lingual 8-9
bony relationship 7-9
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Orthodontic extrusion and bring the roots together. Look at this lecture here at Dentalxp that shows almost an identical case. regards Dr. Salama
Part 1 -
Part 2 -


I concur with Dr Salama.

The osseous deficiency #08-09 is extreme and requires orthodontic movement of the teeth and their associated alveolar bone in order to properly address it.

This is true whether maintaining or extracting and/or restoring via pontics, implant borne or combination prostho. Changes in osseous position and dimension intra and post-ortho will determine soft tissue changes and will dictate the eventual gingival topography. Extrusion of and root rotation of teeth #08 and 09 will bring alveolus and gingiva to levels not attainable or desirable via grafting. Optimally you will orthodontically develop papillae and desirable esthetics.

I would place single maxillary anterior provisional restorations, initiate ortho movement and, once optimal alveolar and gingival dimensions and heights/breadths were attained (and stabilized), finalize the restorative and/or implant treatment plan and treatment. The only grafting to be considered, in my opinion, would be post-ortho and only if required as an adjunct.

The Dental Xp presentation on this methodology that Dr Salama references is excellent.


Henry Schein