Long-Term Outcomes of Occlusal Force Management in Severe Maxillary Canine Regeneration: A Report of Two Cases

Maxillary canines present unique challenges in periodontal regenerative therapy due to their complex biomechanical roles. However, the long-term effectiveness of combining periodontal regenerative therapy and occlusal force management for severely compromised maxillary canines remains unclear. This report aims to address these challenges. Two cases of severe periodontal bone loss in maxillary canines, extending to the apical region, were treated with regenerative procedures and occlusal force management. Treatment involved initial periodontal therapy, regenerative therapy using the modified papilla preservation technique with enamel matrix derivative and bone grafts, and distributing occlusal force to both the maxillary canine and premolar while eliminating premature contact. The cases were followed up for eight and five years, respectively. Both cases showed significant improvement, with the probing depth reduced by 3-4 mm and corresponding improvements in clinical attachment levels. Case 1 required two regenerative procedures and prosthetic intervention while Case 2 achieved stability with a single procedure. Long-term follow-up demonstrated stable periodontal tissues and radiographic evidence of bone regeneration. Tooth mobility was reduced from grade II to grade 0 in both cases. This report suggests that integrating periodontal regeneration with careful occlusal force management can result in long-term stability for severely compromised maxillary canines. These findings may inform treatment protocols for complex cases involving teeth subjected to significant biomechanical stress.