Gtr &Bone Grafting For Midline Alveolar Hypoplasia With Gingival Inversion

A patient presented with inverted upper anterior gingiva, a thickened labial frenum, and a significant diastema between the maxillary central incisors, compromising aesthetics and speech. Orthodontic therapy alone proved insufficient for gap closure, necessitating adjunctive periodontal surgery to address the issue. A 31-year-old systemically healthy female presented with a 5mm diastema between maxillary central incisors (teeht11-21), gingival papilla central depression extending palatally(probing depth: 5mm; width: 6mm), and a high-attaching thickened labial frenum.CBCT imaging revealed a concave alveolar bone defect communicating with the incisive foramen. During periodontal surgery, Full-thickness flaps were elevated labially and palatally, exposing concave bone defect 4 mm subcrestal. Surgical management included debridement, alveolar bone recontouring, connective tissue trimming, and grafting with Bio-Oss bone substitute (Geistlich) covered by a collagen membrane(GTR). Concurrent frenectomy involved frenum release and repair using a collagen membrane(Geistlich). Postoperative orthodontic therapy achieved stable diastema closure with restored gingival architecture. The surgery restored the alveolar bone height and width between teeth11 and 21, correcting the gingival papillae inversion and facilitating orthodontic gap closure. One-year follow-up confirmed stable closure with normalized papillary height and physiologic alveolar crest contour. Gingival inversion with alveolar bone defects communicating with the incisive foramen is rare in adults. A comprehensive understanding of the condition, accurate diagnosis, and timely combined periodontal surgery treatment, utilizing GTR/bone grafting techniques, can yield satisfactory results before orthodontic treatment.