Surgical-prosthetic management of an advanced stage IV periodontitis in the aesthetic zone: A case report

Stage IV periodontitis is a severe form of periodontal disease leading to significant bone resorption, potential tooth loss and masticatory dysfunction. The objective of this article is to show the interest of multidisciplinary management in the treatment of tissue deficits caused by advanced stage IV periodontitis. We report the case of a 29-year-old female patient who lost both upper right incisors due to advanced stage IV periodontitis. Advanced ridge defects caused by periodontitis were managed by two autogenous connective tissue grafts performed in two stages using the pocket technique allowing obtaining a significant increase in height and thickness of the ridge. An associated corrective gingivectomy made it possible to perfect the alignment of the gingival margins and ensure good integration of the future prosthetic rehabilitation. A temporary bridge of ovoid pontic design helped guiding post-surgical healing and ensure better distribution of occlusal loads while respecting the adaptive threshold of the weakened periodontal terrain and taking into account the patient's physiological anatomical landmarks thanks to the axiographic recording of the sagittal condylar inclination (SCI). One year after complete healing, definitive restorations were able to be placed combining aesthetics and function. This case report showed that the soft tissue grafting step by step by pouch technique associated with corrective gingivectomy can be considered as an effective therapeutic alternative to guided bone regeneration in the management of advanced ridge defects due to periodontal disease. Additionally, tooth-supported fixed prostheses can lead to better results without the need for implant therapy.