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Clinical examination revealed the presence of a 13 mm deep periodontal pocket associated with an enamel alteration on the palatal side of 1.2.
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The clinical examination revealed the presence of one isolated periodontal pocket (measuring 13 mm) in correspondence of the palatal aspect of 1.2, in the presence of one enamel alteration (PRG) (Figure 1).
An angular bone defect was also visible through intraoral radiographic examination.
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Radiographic examination showed a deep intrabony defect distal to 1.2 (Figure 2).
PMC6589302_02
A horizontal incision on the palatal aspect was performed, preserving the interdental papilla.
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After local anesthesia on the vestibular and palatal side with Articaine 4%+epinephrine 1 : 100.000, a horizontal incision was performed on the palatal aspect preserving interdental papilla between 1.1 and 1.2 and between 1.3 and 1.4 (Figure 3).
The reflection of the flap, including the papilla between 1.2 and 1.3, allowed a direct visualization of the intrabony defect and the radicular groove.
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The papilla between 1.2 and 1.3 was separated from the vestibular portion and reflected in order to directly visualize the PRG and the defect (Figure 4).
Granulation tissue was removed from the intrabony defect.
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After the debridement of the defect, by removing the granulation tissue, the PRG was smoothed by the use of a diamond bur under abundant irrigation of sterile saline solution (Figures 5 and 6).
Using a diamond bur with copious irrigation of sterile saline solution, the enamel alteration was removed.
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After the debridement of the defect, by removing the granulation tissue, the PRG was smoothed by the use of a diamond bur under abundant irrigation of sterile saline solution (Figures 5 and 6).
The bone substitute was placed in the osseous defect after it had been conditioned through a 24% EDTA gel and irrigated with abundant sterile saline solution.
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Following the instructions provided by the manufacturer, tooth surface was conditioned for two minutes with 24% EDTA gel (Straumann  PrefGel , Straumann AG, Basel, Switzerland) and, after its removal through copious irrigation with sterile saline solution, EMD (Straumann  Emdogain , Straumann AG, Basel, Switzerland) was placed in the defect (Figure 7).
Single 5/0 and 6/0 sutures were placed.
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The flap was then sutured with single 5/0 and 6/0 sutures (ETHILON , Ethicon Inc., Johnson & Johnson, Piscataway, NJ, United States) (Figure 8).
Clinical examination after 12 months.
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Radiographic examination after 12 months.
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PMC6589302_03
Clinical examination: a 10 mm periodontal pocket is associated with 1.2 in correspondence of a palatal groove.
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The clinical examination revealed the presence of one deep narrow isolated periodontal pocket (PD = 10 mm) in correspondence of the palatal aspect of 1.2, in the presence of bleeding on probing, no plaque accumulation, and one PRG (Figure 11).
Radiographic examination: no bone resorption is visible in correspondence of the involved tooth.
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Radiographic examination showed no evidence of one visible intrabony defect (Figure 12).
After a flap was reflected and direct visualization of the defect was obtained, debridement of the periodontal lesion was performed and the radicular groove was smoothed.
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The radicular groove was smoothed using a diamond bur.
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Clinical examination after 12 months.
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