An Imperfect (Dental) World

This week’s case comes to us courtesy of a  72 year old caucasion female- Grandmother of 6 and retired superintendent of schools in her local county. She presented for evaluation and treatment of what turned out to be garden variety Periodontitis made all the more complicated by the fact that she adamantly refused to have any of her clinically unacceptable crown and bridge restorations replaced; as it was ” too expensive ” and “not worth it.” She scheduled the full mouth LANAP surgery for a week after she got back from her short 4-day ” get-a-way ” vacation to Puerto Rico.

Pre-Op Photo showing Diastema 9-10 with Ill fitting
crowns and significant Inflammatory component.
( N.B.-#’s 9&10 have significant mobility with #10 being
depressible.)

The case went well and here we will focus on one curious area- 9-10. #10 was depressible, suppurative and the duration of the diastema was approx 9 mos. The restorative Dr. wanted it out and a fixture placed- as did I. As we weren’t the deciding factors- the tooth stayed to live another day, and the assumption was that it would exfoliate on its own and we would proceed with the implant at that time. Occlusal adjustment was performed throughout the entire mouth at the time of surgery and at every post-op.

1 month post-op with resolving lesion apical #10.
(This is notable too… LANAP cases tend to heal in a fashion that clearly
defines the Mucogingival Junction) Tissue contours have returned
as close as possible to physiologic dimensions.

Much to my surprise ( then-not now) the tooth slowly began to heal as evidenced by the series of photos seen below. At first the tissue apical to interproximal 9-10 began to heal from papilla up, with the lesion  decreasing in size until at about 23 months- it was gone completely.Very Strange. There is currently no mobility, BOP or pathologic pocketing in that or any other area.  Most interestingly- the papilla for the most part- has not disappeared.

6 month p.o. from full mouth LANAP. Diastema closing

My question is: Has anyone else seen healing of a lesion in this fashion- in such a discreet focal manner? If so- do you have any idea why this might be so?  All answers are appreciated.

2 year post-op. Probing depths WNL. Minimal spacing
and excellent overall tissue-tone.Neither 9 or 10 exhibit
any pathologic mobilities.

Secondly, this case is a great example of why procedures such as LANAP- specifically, and technology-in general- require us to think ” differently than we were taught.” Had I ( or any one of you ) elevated a flap in this area and degranulated- the result would be an esthetic disaster. Moreover, true regeneration can take up to 2 yrs post surgery.. and in this case that was the ticket. The human body has the capacity to heal- if we let it.

As always- if you want to forward this to someone who might want to join in the discussion feel free and if you want out just send me a note to the above address with your request in the subject line…

For anyone who has interesting cases that you would like to publish to this group- send to me under separate cover and if used, you will be given full credit for your contribution. The more that we share the more that we get back.

Thanx For Playing:

Neal