Optimizing esthetic zone periodontal regeneration in a 1-2-wall infrabony defect using recombinant human platelet-derived growth factor BB and β-tricalcium phosphate: A case report

Abstract

Objective: Periodontitis is an inflammatory condition induced by subgingival bacterial dysbiosis, resulting in inflammatory-mediated destruction of tooth-supporting structures, potentially leading to the formation of infrabony defects. This case report describes the treatment of a patient who presented with a combination 1-2-wall defect on tooth 21. To maintain the residual periodontal attachment and minimize esthetic consequences, a regenerative approach was performed using recombinant human platelet-derived growth factor-BB (rh-PDGF-BB) and β-tricalcium phosphate (β-TCP).

Materials and methods: At the time of postscaling/root planing reevaluation, a 34-year-old Asian male initially diagnosed with molar/incisor pattern stage III grade C periodontitis exhibited a 6-mm residual probing depth on the mesiopalatal aspect of tooth 21. Periodontal regenerative surgery was performed using rh-PDGF-BB with β-TCP, without the use of a membrane.

Results: At the 1-year follow-up, a significant reduction in probing depth and radiographic evidence of bone fill were observed. Additionally, re-entry surgery for implant placement at site tooth 23 confirmed bone fill in the defect on tooth 21.

Conclusion: These results demonstrate the efficacy of rh-PDGF-BB with β-TCP in enhancing periodontal regeneration and support its use as a treatment option when treating poorly contained infrabony defects in the esthetic zone.

Keywords: biologic; case report; periodontal regeneration; platelet‐derived growth factor.

Figure 1

Preoperative clinical presentation of the maxillary left central incisor (tooth 21). (a) Facial view. (b) Palatal view demonstrating 6 mm mesiopalatal probing depth. (c) Radiographic image showing an infrabony defect on the mesial aspect of the tooth.

Figure 2

Regenerative periodontal surgical procedure. (a) A sulcular palatal incision with interproximal papilla preservation was made from the maxillary right lateral incisor to the maxillary left lateral incisor (teeth 12–22) and a full thickness mucoperiosteal flap on the palatal was elevated. (b) 1–2‐wall infrabony defect with palatogingival groove of the maxillary left central incisor (tooth 21). (c) 1–2‐wall 8 mm deep infrabony defect on the mesiopalatal aspect of maxillary left central incisor after odontoloplasty of palatogingival groove. (d) Application of β‐TCP pretreated with rh‐PDGF‐BB solution (GEM‐21) over the bony defect. (e) Radiographic image following graft application demonstrating complete fill of the defect with the radiopaque material. (f and g) Use of 5‐0 PGA‐PCL copolymer (Glycolon) to achieve tension‐free primary closure of the facial and palatal flaps, respectively.

Figure 3

Six‐month follow‐up postsurgical follow‐up. (a and b) Excellent healing without exposure of the graft or defect on the facial and palatal, respectively. (c) Radiographic image of the maxillary left central incisor (tooth 21) showing a bone‐like radiopacity in the defect.

Figure 4

One‐year surgical re‐entry. (a and b) Excellent soft tissue healing on the facial and palatal aspects of the maxillary left central incisor (tooth 21), respectively. (c) Radiographic image showing bone‐like radiopacity in the treated defect on the mesial of the maxillary left central incisor (tooth 21). (d) Palatal view showing apparent bone fill of the defect.

Figure 5

Periodontal charting and radiographic images. (a) Baseline charting before phase I therapy. (b) Six‐weeks after phase I therapy charting. (c) Six‐months postsurgical charting. (d) One‐year postsurgical charting. (e) Initial radiograph. (f) One‐year postsurgical radiograph.