Site Augmentation and Site Preservation in the Aesthetic Zone Using a Rotated Pediculated Palatal Connective Tissue Graft

Today’s dentistry is highly driven by aesthetics and the search for better health and well-being. The literature is rich with studies that address the subject of bone loss following tooth removal (Figures 1 to 4). Ridge defect can result from extraction of teeth, developmental anomalies, accidental trauma, or periodontal disease that leads to both horizontal and vertical bone loss. Ridge defects are noticeable, and prosthetic results are subpar unless the underlying deficiency is properly addressed (Figures 5 to 18).

This article will highlight 2 patient cases in which one case (case 1) will address a ridge deficiency resulting from an agenesis of two lateral incisors, and the other case (case 2) will show how to prevent a ridge deficiency immediately after extraction in a highly aesthetic zone using a rotated pediculated palatal connective tissue graft.

Primary Chronic Osteomyelitis Associated with Extraction of a Periodontally Involved Tooth


Osteomyelitis (OM) is an inflammatory condition of bone that involves the medullary cavity and the adjacent cortex. It occurs more frequently in mandible than in the maxilla and is often associated with suppuration and pain.1 The osseous spaces are usually filled with exudates that can lead to pus formation. Chronic osteomyelitis can be the result of a non-treated acute mild inflammation or emerge without a precursor. When osteomyelitis occurs in the mandible, it is usually more diffused and widespread.1-6 Clinical examination alone is often enough to diagnose chronic mandibular osteomyelitis due to the progression of this disease and suppuration.1,2 In cases of chronic osteomyelitis, a radiolucent circumscribed image can be seen encapsulating central radiopaque sequestra, as well as radiopacities of the surrounding bone due to a local osteogenic reaction.7 Patients who present active chronic osteomyelitis usually require long-term use of antibiotic therapy and surgical intervention.7 Treatment requires both antibiotic therapy and surgical debridement, meaning the necrotic bone must be completely removed until the underlying bone starts bleeding.7 Although most cases of OM of the jaws result from dental origins, other sources of infection are possible.2 Although primary OM following extraction of periodontally involved teeth is rare, it is, however, of concern to both the patient and dentist. The following case report describes the presentation of OM and how it was managed.

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