PMC6334543_01
(a) Preoperative horizontal probing depth; (b) preoperative intraoral periapical radiograph
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F1
On clinical examination, the tooth number 46 (FDI System) showed diffuse inflammation, bleeding on probing, presence of subgingival deposits, vertical probing pocket depth of 6 mm, relative vertical clinical attachment level of 9 mm, and buccal horizontal probing depth of 6 mm (Hamp's Class II furcation defect) [Figure 1a]. It showed radiolucency in the furcation area [Figure 1b], suggestive of furcation involvement. Subsequently, the patient was evaluated at the end of 8 weeks, it was observed that the vertical probing pocket depth reduced was reduced from 6 to 4 mm, there was a gain in relative vertical clinical attachment level from 9 to 7 mm and the horizontal probing depth remained 6 mm [Figure 1a].
(a) Incisions; (b and c) periosteal pedicle flap reflected; (d) bone graft placed; (e) inner periosteal pedicle flap sutured; (f) Outer partial thickness flap sutured
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F2
Under local anesthesia and all aseptic conditions with #15c blade an initial sulcular incision was made, following which a mesial and distal full thickness vertical releasing incision were made [Figure 2a], and a trapezoidal partial thickness flap was reflected. Then, the underlying periosteal pedicle flap was reflected up to the mucogingival junction connected with mesial and distal vertical releasing incisions [Figure 2b and c]. Care was taken that the defects were adequately filled and not under or overfilled [Figure 2d]. Then, the periosteal pedicle flap was coronally advanced, overlying the bone graft contained furcation defect and sutured with 4-0 resorbable suture using one sling suture [Figure 2e]. The coronally positioned outer partial thickness flap was sutured with 5-0 non-resorbable silk suture using simple interrupted sutures for vertical releasing incisions and the first horizontal incisions [Figure 2f].
(a) Postoperative horizontal probing depth, (b) Postoperative Intraoral periapical radiograph
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F3
At 3, 6, and 12 months, the horizontal probing depth was 3, 3, and 2 mm [Figure 3a] respectively and the vertical probing pocket depth was 3, 2, and 2 mm respectively. At 12 months, an IOPAR using lone cone paralleling technique with the previously used millimeter grid scale was repeated, and it revealed an increase in the radiopacity in the furcation area in comparison to baseline [Figure 3b].