treatment of a localized stage iii periodontitis in the esthetic zone with guided tissue regeneration technique on a heavy smoker patient with 12-year follow- up: a case report

This case report exhibits a heavy smoker female patient with a localized stage iii periodontitis who has been under cessation smoking program during the pre-surgical period, followed by a strict maintenance program for the past twelve years, after being treated with guided tissue regeneration techniques and restored with zirconia prosthetic crowns. a 50-year-old, heavy smoker (> 40 cigarettes per day), systemically healthy female patient presented complaining of mobility and pain in the upper right central incisor which was temporarily splinted to the left central incisor using resin composite. after clinical and radiographic examination, significant damage of the attachment apparatus, deep periodontal lesions extending the middle portion of the root, and severe infrabony defect were noted. following the initial hygienic phase, a guided tissue regeneration surgery using xynograft bone substitute covered by a resorbable collagen membrane was performed. after six months of healing, four zirconia crowns were cemented on the central and lateral incisors based on patient esthetic compliance. during the 12-year follow-up period, neither residual pockets nor gingival recession were observed, and perfect marginal bone stability, and esthetic and functional results were noted. this case shows the predictability of a conservative surgical technique, the guided tissue regeneration, based on appropriate treatment planning and a strict maintenance program, it also demonstrates the importance of at least a 6-month healing period after such surgeries, allowing complete tissue maturation and a re-establishment of the supra osseous gingival tissues in order to locate the prosthetic margins without interfering with the soft tissues integrity.