Regenerative Strategy For "Hopeless" Anterior Tooth Preservation

This case demonstrates the feasibility of preserving severely compromised lower anterior teeth through multidisciplinary intervention, challenging the conventional extraction paradigm in periodontally "hopeless" cases. A 42-year-old male sought periodontal evaluation in our Department in 2023, for progressively mobile mandibular incisor of 7 years' duration. Clinical examination revealed: Tooth #41: Probing depth >10mm with pus discharge. Negative response to electric pulp testing. Radiographs revealed periapical bone loss extending beyond tooth #41 apex. Treatment included: Endodontic treatment of tooth #41; Splinting with composite; Subgingival scaling/root planing; Regenerative surgery using Bone graft with PerioGlas® (bioactive glass, NovaBone) and Geistlich Bio-Gide® membrane placement (collagen barrier, Geistlich Pharma). Serial postoperative evaluations at 2 weeks, 2, 6, 12 and 18 months demonstrated: Probing depth reduction from 10mm to ≤3mm and radiographs bone fill. This case demonstrates the possibility of preserving severely compromised anterior teeth through meticulous multidisciplinary management. While the 18-month follow-up period remains limited, the successful outcome challenges the traditional "hopeless tooth" paradigm and provides valuable clinical insights. Decision-making Rationale: Two key factors supported the preservation attempt: 1) Patient-specific advantages: Favorable host factors (age 42, non-smoker, no systemic disease); Strong patient motivation and compliance with oral hygiene and recalling. 2) Technical considerations: Completed root canal treatment and provisional splinting prior to regenerative surgery. This case redefines "hopeless" tooth prognosis through evidence-based regenerative protocols, offering a tissue-preserving alternative to extraction in selected cases. Long-term stability requires strict adherence to supportive periodontal therapy.