Comprehensive Periodontal Regenerative Care: Combination Therapy Involving Bone Allograft, a Biologic, a Barrier, and a Subepithelial Connective Tissue Graft to Correct Hard‐ and Soft‐Tissue Deformities

Abstract

Type of Case: A 70‐year‐old white female was referred for evaluation and treatment of isolated periodontal lesions throughout her mouth. Her chief concern was the soft‐tissue deformity that was present on her maxillary right canine. Radiographic evaluation of this area revealed that, along with this mucogingival defect, there was an intrabony lesion that required treatment. Case Presentation: The ability to enhance the prognosis and appearance of this tooth by restoring the hard‐tissue support and soft‐tissue profile in the same procedure has rarely been reported in the literature. This case report focuses on a layered approach that simultaneously addresses both aspects of the patient's problem. Treatment involved a mineralized allograft, a biologic agent, an amnion–chorion barrier, and a subepithelial connective tissue graft on a root treated with tetracycline. Conclusions: The clinical and radiographic results at 6 months suggest a very favorable result. Efforts to treat teeth that have both hard‐ and soft‐tissue deformities should consider combination therapies that address both concerns.

Amnion and Chorion Membranes: Potential Stem Cell Reservoir with Wide Applications in Periodontics

“… Rosen in 2011 used a combined approach for correcting both the hard- and soft-tissue deformities around a maxillary canine that included a mineralized bone allograft, recombinant platelet derived growth factor, and a chorion amnion barrier covered by a subepithelial connective tissue graft. The advantages of this particular barrier are that it is extremely thin, measuring 300 mm after full hydration, with the major noncollagenous components being laminins, proteoglycans, and fibronectin, further enhancing its tissue friendly nature [ 69 ]. Kothari et al in 2012 also concluded that grafts of amniotic membrane are viable and reliable for covering of the raw surface, prevent secondary contraction after vestibuloplasty, and maintain the postoperative vestibular depth [ 70 ].…”

Maxillary Sinus Membrane Repair With Amnion–Chorion Barriers: A Retrospective Case Series

“…Amnionchorion barriers also contain a variety of proteins including collagen types I, III, IV, V, and VI, laminin-5, platelet-derived growth factor-a (PDGF-a), PDGF-b, fibroblast growth factor; and transforming growth factor-b that help to facilitate wound healing. 16 While reports have been published with amnion-chorion barriers being used in dental procedures such as guided tissue regeneration of periodontal intrabony defects 11,12 and extraction site preservation, 13 this is the first known article to report on the use of amnion-chorion for the repair of sinus membrane perforation. The findings of this article in regards to implant survival rates compare favorably to results of previously published studies examining repair of sinus membrane perforations with various other materials including fixed absorbable collagen membranes, Lambone, and subepithelial connective tissue grafts.…”

“…[8][9][10] These reparative options, however, have proven to be technique sensitive and time consuming. Amnion-chorion is a relatively new material to the dental market and has proven effective for periodontal treatments such as guided tissue regeneration 11,12 and extraction site preservation. 13 The aim of this case series is to present a quick and simplified option for the repair of Schneiderian membrane perforations with amnion-chorion barriers.…”

Maxillary Sinus Membrane Repair With Amnion-Chorion Barriers: A Retrospective Case Series

“…Amnionchorion barriers also contain a variety of proteins including collagen types I, III, IV, V, and VI, laminin-5, platelet-derived growth factor-a (PDGF-a), PDGF-b, fibroblast growth factor; and transforming growth factor-b that help to facilitate wound healing. 16 While reports have been published with amnion-chorion barriers being used in dental procedures such as guided tissue regeneration of periodontal intrabony defects 11,12 and extraction site preservation, 13 this is the first known article to report on the use of amnion-chorion for the repair of sinus membrane perforation. The findings of this article in regards to implant survival rates compare favorably to results of previously published studies examining repair of sinus membrane perforations with various other materials including fixed absorbable collagen membranes, Lambone, and subepithelial connective tissue grafts.…”

“…[8][9][10] These reparative options, however, have proven to be technique sensitive and time consuming. Amnion-chorion is a relatively new material to the dental market and has proven effective for periodontal treatments such as guided tissue regeneration 11,12 and extraction site preservation. 13 The aim of this case series is to present a quick and simplified option for the repair of Schneiderian membrane perforations with amnion-chorion barriers.…”