PMC4365146_01
Clinical preoperative view of maxillary anterior teeth
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F1
An aberrant frenum was also noted, which demonstrated a positive pull on the interdental papilla [Figure 1].
Preoperative radiograph showing the vertical defect in relation to the maxillary left central incisor
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F2
Intraoral periapical radiograph showed vertical bone loss in relation to the mesial aspect of maxillary left central incisor [Figure 2].
Initial two semilunar incisions
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F3
The medial extensions of both the semilunar incisions excised only the base of the frenal attachment, preserving the continuity of the flap [Figure 3].
Intraoperative view of the defect
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F4
The flap was elevated from the buccal to the palatal aspect visualizing the intra-osseous defect [Figure 4].
Alloplastic graft placed in the defect
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F5
After root biomodification with tetracycline hydrochloride, the defect was filled with an alloplastic graft material containing porous hydroxyapatite and bioactive glass [Figure 5].
Flap sutured
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F6
A frenotomy was also performed to relocate the aberrant frenal attachment [Figure 6].
Clinical picture at suture removal
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F7
Sutures were removed 10 days after surgery [Figure 7].
Six months postoperative view
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F8
A wider zone of attached gingiva was evident at the site [Figure 8].
Six months postoperative radiograph showing bone fill of the defect
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F9
Radiograph demonstrated complete fill of the defect [Figure 9].