PMC3265097_01
(a)-(d) Deep pockets were present even though signs of gingival inflammation other than bleeding on probing were absent.
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fig5
Periodontal charting showing generalized deep pockets and clinical attachment loss.
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fig6
Orthopantomogram of the patient demonstrating generalized distribution of bone loss.
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fig7
 An OPG and full-mouth IOPA X-ray were performed which revealed the generalized distribution of alveolar bone loss which was a combination of both horizontal and vertical bone loss (Figure 7).
(a)-(e) Modified Widman flap in conjunction with bone grafting performed. (f) Postoperative evaluation showing probing depth within normal limits. (g) 6-Month postoperative intraoral periapical radiographs.
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fig8
A modified Widman flap surgery in conjunction with bone replacement graft was performed in the molar regions (Figures 8(a)-8(e)) whereas a sulcular incision flap (Kirkland flap) was performed in the maxillary and mandibular anterior region to minimize the recession after healing for esthetic purposes. Healing was uneventful, and a postoperative evaluation 3 weeks after surgery showed absence of bleeding on probing and probing depths within normal limits (Figure 8(f)). A postoperative radiograph 6 months later showed a significant bone fill in the molar regions where grafting was done with an increase in bone density of the alveolar crest with corticated bone formations in the crest at the other areas (Figure 8(g)).
PMC3265097_02
(a) and (b) Clinical presentation with deep pockets, recession, and pathologic migration of teeth.
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fig9
A 26-year-old male patient presented with the chief complaint of generalized pus discharge from gums which he had been experiencing intermittently for the past 2 years (Figures 9(a) and 9(b)).
Pretreatment periodontal charting shows deep pockets with generalized clinical attachment loss.
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fig10
A full mouth periodontal examination revealed generalized deep periodontal pockets and severe generalized clinical attachment loss (Figure 10).
Orthopantomogram showing generalized bone loss with advanced vertical defect in 13 and 33 regions.
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fig11
 OPG and IOPA X-rays revealed a generalized distribution of periodontal bone loss especially severe in the incisor and canine regions with the molars and premolars affected to a lesser degree (Figure 11).
(a)-(c) Flap surgery in conjunction with bone grafting (HAP) and papilla preservation flap between 11 and 21. (d)-(f) Deep circumferential defect treated with bone grafting in conjunction with guided tissue regeneration.
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fig12
In addition, the defect at site 33 was treated with guided tissue regeneration (GTR) with bioresorbable collagen membrane in conjunction with synthetic bone graft (HAP) (Figures 12(a)-12(f)).
(a) and (b) Postoperative photographs showing probing depths within normal limits with excellent gingival condition; however, there was slight increase in recession after healing. (c) and (d) Comparison of preoperative and 1 year postoperative radiographs shows good bone fill at the defect in relation to 33.
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fig13
Postoperative clinical evaluation showed excellent gingival condition with reduction in probing depths to normal levels (Figures 13(a) and 13(b)). Radiographs showed bone fill in the region where bone grafts alone or in conjunction with GTR were used (Figures 13(c) and 13(d)).