Connective tissue graft wall technique with concentrated growth factors and allograft: A case series.

Abstract

Background: Severe periodontitis often results in extensive attachment loss and non-contained bony defects, compromising regenerative predictability. This case series evaluates the clinical and radiographic outcomes of treating extensive infrabony defects with buccal dehiscence using a synergistic approach: the connective tissue graft (CTG) wall technique combined with freeze-dried bone allograft (FDBA) and concentrated growth factors (CGF).

Methods: Two patients underwent regenerative surgery following initial periodontal therapy. Intraoperatively, two-wall, non-contained defects with complete buccal bone dehiscence were identified. The defects were grafted with "CGF sticky bone" (FDBA mixed with CGF). A CTG was secured to the interdental papillae and periosteum to establish a biological barrier, followed by a coronally advanced flap for closure.

Results: At the 8-month follow-up, both cases demonstrated significant pocket probing depth reduction (<4 mm) and clinical attachment level gains (4-5 mm). While minor residual gingival recession and partial papilla collapse occurred, a notable increase in gingival thickness was observed. Periapical radiographs confirmed substantial infrabony bone fill and increased radiopacity within the previous defects.

Conclusion: The combination of the CTG wall technique, FDBA, and CGF provides a viable strategy for managing complex, non-contained periodontal defects. This integrated approach effectively stabilizes graft materials and improves soft tissue quality, though complete prevention of recession in advanced defects remains a clinical challenge.

Key points: Regenerating non-contained infrabony defects remains clinically challenging due to compromised space maintenance and wound stability. This case series demonstrates that the CTG wall technique, integrated with FDBA and CGF, effectively manages these complex defects by providing a stable biological barrier. This approach yields favorable short-term CAL gains, substantial radiographic bone fill, and beneficial soft tissue phenotype modification, even in cases with extensive buccal bone loss.

Plain language summary: Periodontitis is a severe gum infection that destroys the supporting tissues and bone around teeth, often leading to tooth loss. Traditional treatments sometimes struggle to fully regrow these lost structures. This study introduces a specialized surgical approach called the "CTG Wall Technique." By combining a patient's own gum tissue with advanced blood-derived growth factors and bone graft materials, we created a biological "wall" to stabilize the wound and enhance healing. We applied this method to patients with deep bone defects and followed their progress. The results showed significant improvement in gum attachment and bone height. This technique offers a promising, biological way to save teeth that might otherwise be lost to gum disease, providing a more predictable outcome for both clinicians and patients.