case_images: PMC9869000_01
case_images: A) Preoperative radiograph, vertical bone loss extended to the apex mesially and distally; B) Clinical photograph, extruded right central incisor and pathologic migration; C) Flap design with modified papilla preservation method; D) Flap reflected and defect debrided thoroughly; E) GTR procedure performed around right central incisors and teeth splinted; F) Flap adaptation and suturing
case_images: IEJ-17-212-g001.jpg
case_images: PMC9869000_01_IEJ-17-212-g001.jpg
case_images: F1
case_images: In clinical examination, the tooth was 3 mm supra-erupted compared to adjacent central incisor and showed sever mobility in both horizontal and vertical dimensions (grade III mobility, Miller classification; Figures1A and 1B). Under local infiltration anesthesia with 2% lidocaine containing 1:80000 epinephrine (Darupakhsh, Tehran, Iran), a modified papilla preservation flap was performed (Figure 1C) and the buccal and palatal flap was elevated thoroughly to have a good vision of bony defect (Figure 1D). Tehran, Iran) placed all over the apical third of the root (Figure 1E), and collagenic membrane (0.3-0.6 mm precordium membrane; Regen Allograft, Tehran, Iran) was used to stabilize the bone material. The flap was repositioned and secured with vicryl 5-0 (Supa, Tehran, Iran; Figure 1F). Amoxicillin and 0.2 % chlorhexidine mouthwash were prescribed for the patient for 1 week. 
case_images: A) Six months follow-up with reduced pocket depth mesially; B) Follow up photograph with reduced pocket depth to 3 mm palatally; C) Follow-up and pocket depth 3 mm labially; D) Composite splinting and central incisor reshaping; E & F) CBCT radiograph 8 months after GTR procedure; note alveolar bone formed labially and mesio-distally; G) Periapical radiographs after 12 months, notable bone formation apico-coronally
case_images: IEJ-17-212-g002.jpg
case_images: PMC9869000_01_IEJ-17-212-g002.jpg
case_images: F2
case_images: Clinical evaluation showed a significant decrease in probing depth (the uppermost PD was 3 mm in mid-palatal) without BOP (Figures 2A to 2C). So the tooth was splinted to the adjacent incisor with composite resin (Figure 2D) and the patient asked to use an interdental brush. Eight months post-operative, a cone-beam computed tomography (CBCT) scan was taken (Figures 2E and 2F). Twelve-month follow-up showed stable results, no BOP, and PD was 1-2 mm (Figure 2G).