Periodontal disease is bacterial invasion of the tissue that surrounds the teeth destroying the attachment to the roots of the teeth and the bone that surrounds the teeth. This process creates “pockets” around the teeth filled with bacteria. In order to remove the infection surgery is performed to remove the pocket. Traditional surgery called osseous surgery removes the gingiva (gums) and bone around the pocket thus eliminating the pocket. The positive side of this surgery is that the remaining tissue is healthy and the disease can be controlled but the negative side of this surgery is that significant tissue is removed around the teeth leaving exposed roots that are sensitive and unattractive. In addition osseous surgery does not replace the tissue lost to the disease The Inverted Periosteal Graft and Regen Biocement was developed to regenerate the lost tissue and return the gingiva and bone to normal. The following case illustrates how tissue was removed by osseous surgery years ago to treat periodontal disease and how the Inverted Periosteal Graft can be used to regenerate the tissue removed during osseous surgery.

The following patient was referred to The Bone Institute for recurrent periodontal disease in the upper molars. She was middle aged with a history of osteoporosis and bisphosphonate therapy. The appearance of her anterior teeth caused her to cover her mouth when she smiled. Regenerative surgery was planned to treat the periodontal disease on the upper right molars.  While the bicuspids were healthy she wanted regenerative therapy in this area in an attempt to regenerated bone and gingiva on her upper right bicuspids for esthetic reasons.


 Significant recession throughout the dentition as a result of periodontal disease and osseous surgery.

 Two weeks after surgery the sutures are removed.

Regenerative surgery requires approximately 6 weeks to complete the regenerative process from a clinical standpoint. The patient was very pleased with the improvement in esthetics around her bicuspids and she requested regenerative surgery be performed to her maxillary anterior bone and gingiva for esthetic reasons.

 Appearance of maxillary anterior teeth prior to regenerative surgery.

The patient presented with generalized recession. Teeth #7 and #10 had previously been removed and were replaced with Maryland bridges. The plan was to remove the Maryland bridges and regenerate the horizontal bone loss for esthetics and regenerate the bone resorption in the area of 7 and 10 in order to have adequate bone width for implants in the area of 7 and 10.

 After regenerative surgery, implants and crowns with improved esthetics.

 Post operative smile.

Restorative dentistry by Dr. Warren Francis Santa Rosa Ca.

Regenerating bone and gingiva is much more difficult after it has been surgically removed. This case required combined regenerative periodontal therapy using the Inverted Periosteal Graft with Regen Biocement, implants to replace the maxillary lateral incisor teeth and crowns on the six maxillary anterior teeth. For the first time in years the patient smiles confidently without covering her mouth.