Conservative Treatment to Delay Implant

A 59-year-old man has chronic periodontitis.  The furcal infection of the tooth #18 recurs (Fig.1 <) 4.5 years after osseous surgery without bone graft.  The tooth #20 has bone loss distally with subgingival calculus (Fig.1 >).  Gingival flap surgery is performed buccally (from 18 D to 21 D and lingually (from 19 D to 21 D) to remove granulation tissue and calculus (Fig.2).  Since the bony defects are relatively small, smaller particulate bone graft (.25-.85 mm demineralized cortical allograft) is chosen instead of .5-1 mm or 1-2 mm mineralized cancellous and cortical one.  The problem is the invisibility of the graft immediately postop (Fig.2).  If the surgery is successful, implant treatment can be avoided or delayed.

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Xin Wei, DDS, PhD, MS 1st edition 02/28/2016, last revision 02/28/2016