Periodontal Regeneration: treating severely compromised teeth

Regenerative periodontal treatment can play a major role in tooth retention, especially in severely compromised teeth. But key questions remain: How far can we go? What materials are essential? When is hopeless really hopeless?

Following initial periodontal therapy, some patients still present with residual periodontal pockets that require further intervention through periodontal surgery. In cases involving vertical bony defects or furcation involvement, regenerative periodontal therapy can result in new attachment formation, thereby supporting long-term tooth retention and improving prognosis.

Even in severely compromised cases, tooth retention is possible—provided that specific patient- and tooth-related factors are taken into account, such as smoking status, inflammation, and the degree of furcation involvement before proceeding with surgery.

A thorough understanding of the three-dimensional morphology of the bony defect is also essential for choosing the right regenerative materials or material combinations. In severe one- or two-wall defects, the use of Bone Lamina can offer high stability, which is crucial for successful regeneration.

However, in certain cases, it is important to recognize the limits of regenerative therapy. Surgical intervention may need to be withheld, and realistic outcomes must be accepted to avoid over-treatment.