Undertreating for Success…..
This is an interesting case not so much for its etiology nor its presentation, but rather because the treatment options prior to LANAP would have required us to have multiple procedures with almost certain untoward esthetic outcomes. An abscess is an abscess is an abscess. This case however, had been chronic in nature and the pre-op probing had been 12mm along the mesial aspect of the tooth. Coupled with suppuration and bleeding- any flap/curettage for debridement would have certainly resulted in significant recession. Placement of a membrane/graft would be difficult as it the topography of the bony defect didnt really lend itself to this type of repair. ( as you can see from the film ).
Rather than treat with traditional LANAP- the fiber was inserted directly into the fistula to the point of resistance and then spiraled back out. The tooth, upon presentation had class II mobility as would be expected.
This is an excellent option for those patients that present with similar abscesses and or esthetic gingigval conditions.. RCT was not indicated and conventional periodontal modalities would be tantamount to “bringing a automatic weapon to BB gun rally.” or something like that… Of particular import is that the papilla was not lost nor was there any concomitant loss of tissue height/volume. This is something that we ( as well as patients ) are always concerned about. Given that the point of ingress was through the fistula, we are able to bypass these problems altogether. The take home point here.. is as always.. “better to EFFECT it, than to RESECT it… ”
We are here to heal but when we are able to offer healing in way that make patients happy about how they look- that is a home run…..As with all communications… constructive criticism is always welcome..
Be Good and to those celebrating have a Happy New Year…
The sequence below is as follows:
1) pre-op May 2012 Fistula noted in vestibule apical to #7
2) immediate post-op with fistula denuded
3) 2 week post-op.. “fibrin-fill ” of site
4) 4 month post-op n.b.- tooth has no mobility and no suppuration /bleeding present.
The expectation is that the are will fill in over time. 4 mos is generally too short for any real regeneration to occur and it will be watched for up to 24 months. In the meantime- the patient is thrilled and there is loss of tissue height/volume.
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