case_images: PMC4365146_01
case_images: Clinical preoperative view of maxillary anterior teeth
case_images: JISP-19-103-g001.jpg
case_images: PMC4365146_01_JISP-19-103-g001.jpg
case_images: F1
case_images: An aberrant frenum was also noted, which demonstrated a positive pull on the interdental papilla [Figure 1].
case_images: Preoperative radiograph showing the vertical defect in relation to the maxillary left central incisor
case_images: JISP-19-103-g002.jpg
case_images: PMC4365146_01_JISP-19-103-g002.jpg
case_images: F2
case_images: Intraoral periapical radiograph showed vertical bone loss in relation to the mesial aspect of maxillary left central incisor [Figure 2].
case_images: Initial two semilunar incisions
case_images: JISP-19-103-g003.jpg
case_images: PMC4365146_01_JISP-19-103-g003.jpg
case_images: F3
case_images: The medial extensions of both the semilunar incisions excised only the base of the frenal attachment, preserving the continuity of the flap [Figure 3].
case_images: Intraoperative view of the defect
case_images: JISP-19-103-g004.jpg
case_images: PMC4365146_01_JISP-19-103-g004.jpg
case_images: F4
case_images: The flap was elevated from the buccal to the palatal aspect visualizing the intra-osseous defect [Figure 4].
case_images: Alloplastic graft placed in the defect
case_images: JISP-19-103-g005.jpg
case_images: PMC4365146_01_JISP-19-103-g005.jpg
case_images: F5
case_images: After root biomodification with tetracycline hydrochloride, the defect was filled with an alloplastic graft material containing porous hydroxyapatite and bioactive glass [Figure 5].
case_images: Flap sutured
case_images: JISP-19-103-g006.jpg
case_images: PMC4365146_01_JISP-19-103-g006.jpg
case_images: F6
case_images: A frenotomy was also performed to relocate the aberrant frenal attachment [Figure 6].
case_images: Clinical picture at suture removal
case_images: JISP-19-103-g007.jpg
case_images: PMC4365146_01_JISP-19-103-g007.jpg
case_images: F7
case_images: Sutures were removed 10 days after surgery [Figure 7].
case_images: Six months postoperative view
case_images: JISP-19-103-g008.jpg
case_images: PMC4365146_01_JISP-19-103-g008.jpg
case_images: F8
case_images: A wider zone of attached gingiva was evident at the site [Figure 8].
case_images: Six months postoperative radiograph showing bone fill of the defect
case_images: JISP-19-103-g009.jpg
case_images: PMC4365146_01_JISP-19-103-g009.jpg
case_images: F9
case_images: Radiograph demonstrated complete fill of the defect [Figure 9].