(69) The usage of the semilunar incision to enhance the esthetic outcome in guided tissue regeneration

Introduction: Conventional periodontal flap design for guided tissue regeneration allows for accessibility and visualization of the bony defect. However, the flap's healing may be frequently impacted by different flap designs, which may lead to poor esthetic results such as gingival sloughing. This highlights the need to utilize an alternative flap design during the regenerative procedure when working in the esthetics zone. The semilunar incision has been extensively described in the context of mucogingival procedures for root coverage as a papilla preservation technique. In this case report, we present the usage of a semilunar incision during guided tissue regeneration to improve the esthetic outcome.

Methods: Patient A, 49 y/o male, presents to the periodontics clinic with isolated deep probing depths of 3-9mm with bleeding on probing, lingual suppuration, and radiographic infrabony defect on #9. The periodontal defect was treated with scaling and root planning, followed by guided tissue regeneration. A semilunar buccal incision was dropped at the mucogingival junction from the distal of #7 to #10, and sulcular lingual incisions from the mesial of #8 to the distal of #9 were made. Periodontal debridement was performed on #9 to remove all plaque, calculus, cementosis and granulation tissue to achieve a smooth root surface; Biologics GEM-21S which contains osteoconductive matrix, β-TCP, was applied to the defect, and 5-0 polypropylene sutures were placed to achieve tension-free primary closure.
The periodontium was evaluated at two weeks and four-months. Post-operative clinical photographs and radiographs were recorded

Results: Significant probing depth reduction and clinical attachment level improvement were noticed in the surgical area. The improvement of the bone fill is verified on the radiography examination. The gingival recession and other mucogingival deficiencies are not seen.

Conclusions: Placing the semilunar incision at the mucogingival junction is an alternative flap design for teeth in the esthetic zone needing guided tissue regeneration. However, the case selection is critical because the accessibility of the flap should be the priority when designing the incision.

Lead Author's Contributions to the Research Project. : The Lead Author was responsible for data analysis and composition of the abstract.