In our previous case, we reviewed the role of scaling and root planing in the treatment of periodontitis. Today’s case provides an opportunity to introduce the favorable effects of surgical techniques.

G.M. is a systemically healthy man who presented in 2023 for treatment of Stage 3 Grade C periodontitis. Scaling and root planing, along with motivation toward improved oral hygiene, were performed and resulted in a reduction of mean probing depths, particularly at shallow and moderate sites. However, a deep, narrow infrabony defect distal to tooth #31 proved particularly difficult to manage with non-surgical therapy alone due to the severity of the probing depth, limited access, and several local anatomical factors, including buccal furcation involvement and root concavities.

Between 2023 and 2024, localized progression of periodontal disease was observed, with increased probing depths and worsening radiographic bone levels.

Periodontal regenerative therapy was performed with the goal of restoring the lost periodontal apparatus, including supporting bone, cementum, and periodontal ligament. A minimally invasive approach limited to the affected tooth was used, followed by thorough debridement of the contaminated root surface and placement of biomaterials within the infrabony defect.

Healing was uneventful and resulted in successful radiographic bone gain and resolution of periodontal disease. The tooth prognosis improved from unfavorable to favorable, allowing preservation of natural dentition and eliminating the need for additional tooth replacement therapy.