A 27-year-old female patient reported with the chief complaint of increasing spacing between her upper front teeth since the last nine months. There was no history of previous dental treatment. Her family and medical history were noncontributory. The patient provided a history that there was no spacing between the maxillary central incisors two years back. A gradual increase in spacing was noticed between the maxillary central incisors over the last nine months. On intraoral examination, other than a poor oral hygiene status, a 9 mm deep periodontal pocket was noticed between the maxillary central incisors. Both the teeth were showing Miller's Grade I mobility. There was high labial frenum attachment and a 2 mm diastema was present between the two central incisors []. Functional occlusal evaluation was done, which revealed an increased overbite that could be traumatic to the opposing maxillary teeth. An intraoral periapical radiograph revealed horizontal bone loss in between #11 and #21 [].\nAfter the completion of Phase-1 therapy, the patient was re-evaluated, during which the pocket depth was reduced to 7 mm. There was no gingival recession around the involved teeth. Occlusal equilibration was done to relieve the occlusal interference in the maxillary and mandibular anterior teeth. Periodontal flap surgery, along with excision of the high frenum attachment was planned, explained to the patient, and informed consent was obtained from the patient. Under local anesthesia, frenectomy was performed and a full-thickness mucoperiosteal (papilla preservation) flap was reflected []. Thorough degranulation was followed by root planing and saline irrigation. Black silk was used for suturing and simple interrupted sutures were placed []. Periodontal dressing was also done. The patient was discharged after giving postoperative instructions and prescribing antibiotics and analgesics/anti-inflammatory drugs. After one week, the periodontal dressing and sutures were removed and the area was thoroughly irrigated with saline. Three months postoperatively, there was complete closure of the diastema [] and both the teeth showed no signs of clinical mobility. Intraoral periapical radiographs showed bone gain between the two maxillary central incisors []. At three months, the periodontal probing depth was 3 mm and a gingival recession of 2 mm was noticed around both the maxillary central incisors. The patient was explained the importance of maintenance therapy and also the chances of a relapse of pathological migration in case of recurrence of periodontal disease. The patient was provided the option of a retainer to maintain the tooth in position, which the patient declined. The patient is being followed with no signs of recurrence of pathological migration.
Case 1: A 58-year-old Chinese man complained of large painless GO that started ~10 years ago and progressively worsened.