Regenerative Procedures
Rebuilding What Gum Disease Destroys

Periodontal regeneration is not appropriate for every bone defect — the geometry of the defect critically determines the potential for regeneration. We classify each bony defect using a combination of clinical probing and cone-beam CT or periapical radiographs: two-wall and three-wall intrabony defects have the highest regenerative potential; one-wall and horizontal defects have significantly less. Furcation involvement is classified by class (I through III). This classification directly determines whether regenerative surgery is indicated, which materials are most likely to succeed, and what level of bone gain is realistic to expect.

Under local anesthesia, we create a precisely designed surgical flap to gain access to the bony defect and root surface below the gumline. The flap design is planned pre-operatively to preserve blood supply, maintain papillary tissue, and allow tension-free closure over the regenerative materials. All granulation tissue — the chronic inflammatory tissue that occupies the defect — is meticulously removed, and the root surface is thoroughly debrided and conditioned to remove bacterial deposits and create a biocompatible surface that regenerating cells can adhere to.

A guided tissue regeneration (GTR) membrane is placed over the bone defect to exclude fast-proliferating epithelial cells and fibroblasts from the defect space, while allowing the slower-growing periodontal ligament cells and bone-forming osteoblasts to repopulate it. We use resorbable collagen membranes in most cases — they biodegrade without requiring a second surgical removal procedure. The membrane acts as a biological scaffold and space maintainer, creating the conditions necessary for true periodontal regeneration rather than simple repair.

In most regenerative procedures, we augment the GTR membrane with a bone graft material to provide additional structural support and osteoinductive signals. We commonly use demineralised freeze-dried bone allograft (DFDBA) — a well-researched material derived from cadaveric bone that has been shown to stimulate new bone formation in periodontal defects. For selected patients, we also offer platelet-rich fibrin (PRF) — a concentrated growth-factor preparation derived from the patient's own blood — which provides autogenous biological signals that accelerate healing and may enhance regeneration outcomes.

Wound closure with fine resorbable sutures is performed with precision to achieve primary closure over the regenerative site — any wound dehiscence (opening) in the early healing period significantly compromises the outcome. Post-operative instructions are detailed and specific. Sutures are removed at 10-14 days. We avoid probing the surgical site for at least six months to allow undisturbed healing. A bone-level reassessment radiograph is taken at six months to evaluate regenerative outcomes. Ongoing 3-month maintenance is essential, as newly regenerated tissue is more fragile and requires vigilant support.