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A 48-year-old female patient referred to the Birmingham Dental Hospital for generalized periodontitis presented with a residual 8-mm pocket and infrabony defect around her LL2 after Step 1 and 2 of therapy. Following discussion of treatment options, a minimally invasive non-surgical technique was completed alongside the addition of a biologic, a therapeutic agent applied to enhance regenerative or reparative effects during wound healing and in this case, enamel matrix derivative. At 6 months, pocket closure was evident, as well as radiographic evidence of bony infill. The patient remains in ongoing supportive periodontal therapy at 3-monthly intervals.
CPD/Clinical Relevance: Addition of biologics traditionally used during surgical therapy may provide improvements when used alongside minimally invasive non-surgical treatment.
Article
The ultimate goal of treating periodontitis is not only to resolve the inflammatory lesion and thus prevent progressive attachment loss, but also to regenerate all lost periodontal tissues, i.e. alveolar bone with periodontal ligament inserting into cementum. Traditionally, procedures aimed at regenerating lost periodontal tissues require a surgical approach to access the specific bony defect in question.
Surgical techniques have evolved over the past 50 years as our understanding of the biological principles of wound healing has developed. Surgical approaches necessitate microsurgical instruments and aim to provide minimally invasive approaches to access and manage the defect, allowing for a stable blood clot that can co-ordinate a healing response favouring a regenerative outcome rather than repair.
While novel surgical approaches continue to be described in the literature, with the common theme being papilla preservation, it must be recognized that no incision/flap elevation (i.e. non-surgical therapy) provides the ideal soft tissue compartment to support the regenerative processes to take place.
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