A novel two-stage surgical technique for severe three-dimensional bone atrophy associated with periodontal attachment loss: a case report

Abstract

This report presents a minimally invasive two-stage augmentation approach for managing partial edentulism is associated with severe three-dimensional tissue deficit and periodontal attachment loss. A 51-year-old male presented with a missing maxillary left second molar, accompanied by a 7-mm vertical bone defects and loss of clinical attachment (9 mm) in the distal root of the first molar. The first treatment stage involved vertical regeneration using the guided bone regeneration (GBR) technique with a titanium-reinforced nonresorbable membrane, alongside the periodontal defect regeneration of the adjacent tooth, without elevating the palatine flap. The membrane was pocketed and fixed using the transmucosal technique. After eight months, the second stage commenced with membrane removal, implant insertion, and supracrestal soft tissue augmentation using a connective tissue graft with a bilaminar technique. The implant was exposed five months later, and a lithium A disilicate screw-retained crown was placed. Significant vertical bone increase, enhanced keratinized soft tissue, and a 6-mm clinical attachment gain at the adjacent tooth were observed one year after surgery. Radiographs confirmed stable new hard tissue around the implant and improved periodontal attachment. This case demonstrates the potential of combining GBR and periodontal regeneration techniques to reduce discomfort and surgical interventions while preserving the adjacent natural teeth.