Periodontal regeneration using connective tissue graft wall and xenograft with coronally advanced flap in noncontained intrabony defects: A novel combination technique

The present case report describes the novel combination of connective tissue graft (CTG) wall technique with xenograft for periodontal regeneration of extensive intrabony defects in the esthetic area. A 24-year-old female patient presented with gingival recession with mesial and distal deep bony defects at the upper lateral incisor and probing depths (PDs) of 7 and 5 mm, respectively. The surgical technique involved split-thickness buccal flap elevation, grafting the bone defects with xenograft bone substitute, securing the CTG over the surgical site followed by flap advancement. Uneventful healing was evident with reduction in PDs (5 and 4 mm), recession depths, and improvement in clinical attachment levels after 1 year. Radiographically, bone fill in the intrabony component was evident. It can be concluded that the presented approach combines the benefits of bone substitute's space maintaining and osteoconduction properties with the advantages of CTG wall to support the regeneration site and the overlying flap for improved clinical and radiographic outcomes in deep intrabony defects.