PMC9886481_01
Initial condition. (a) Intraoral condition of gingival region tooth #26 showed recession without visible abscess. (b) Intraoral condition when the patient wore denture with a single clasp on tooth #26 (shown in blue circle). (c) Initial radiograph condition. Overhanging restoration on the distal part of the crown. Radiolucency surrounded the mesial and apical parts of the roots.
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On intraoral examination, no abscess was evident on the gingival region of the upper left maxillary first molar (tooth #26), as shown in Figure 1(a). He wore an upper removable partial denture to replace teeth #13-#17 and #22-#25, with only one half-Jackson clasp anchored on tooth #26 (Figure 1(b)). An area of radiolucency surrounded the mesial and apical parts of the roots with a thickness of approximately 2 mm (Figure 1(c)).
Clinical and radiographic examination of tooth #26 after root canal treatment. (a) Temporary filling covered the mesio-occlusal part of crown tooth #26. Gingiva looked normal. (b) Radiographic examination showed obturation of root canals of tooth #26 with decreased radiolucency on the apical part of the tooth.
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There was a significant pocket reduction on tooth #26, with 6 and 5 mm on the mesial and distal pockets of the tooth, respectively (Figure 2(a)). However, radiolucency on the mesial aspect of the root persisted (Figure 2(b)).
Guided tissue regeneration (GTR). (a) Infrabony defect on the mesial and buccal part of tooth #26, with some bone holding the middle third of the mesial root. (b) Packing of defect with a combination of allograft/alloplastic bone graft. (c) Pericardium membrane was placed over the defect.
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Infrabony defect with a depth of 14 mm was found on the mesial aspect of tooth #26, which extended to the buccal area between tooth #26 and tooth #27 (Figure 3(a)). The defect was filled with bone graft material freeze-dried bone allograft (Batan, Jakarta, DKI Jakarta, Indonesia) and alloplastic (Ossifi, Kansas, MO, USA; Figure 3(b)). A barrier membrane (Batan, Jakarta) was placed over the graft, and the flap was sutured with 5-0 nylon sutures (Ailee, Sasang-gu, Busan, South Korea; Figure 3(c)).
Post-operative condition: (a) One month post-operative: gingival recession was evident, especially on the buccal of tooth #26. (b) Five months post-operative: temporary restoration has been replaced by a metal crown. The gingival margin migrated toward the coronal direction. Scar tissue on mesial of tooth #26 was less noticeable.
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A one-month follow-up showed a gingival recession in the buccal area of tooth #26, which was typical and expected (Figure 4(a)). The tooth exhibited minimum mobility, the gingiva had entirely healed with minimum scar tissue, and creeping attachment was noticeable on the buccal area (Figure 4(b)) compared with the previous position (Figure 4(a)).
Comparison of maxillary denture design: (a) Faulty design of the previous denture with only a single clasp on tooth #26. (b) New design with multiple clasps for better distribution of load.
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Instead of using a single clasp (Figure 5(a)), a new acrylic denture was installed with multiple clasps on teeth #12, #21, and #27 (Figure 5(b)).
Comparison between (a) initial and (b) final clinical and radiographic condition.
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The frenulum at the mesial aspect of tooth #26 was noticeably high, yet no significant recession was found compared with the initial condition (Figure 6).