Restor Dent Endod.  2015 Nov;40(4):314-321. 10.5395/rde.2015.40.4.314.

Management of apicomarginal defect in esthetic region associated with a tooth with anomalies

• Meharwade
• Shah DY
• Mali PP
• Meharwade

• KMID: 2316952
• DOI: http://doi.org/10.5395/rde.2015.40.4.314

Abstract

Tooth related factors such as palatoradicular groove can be one of the causes for localized periodontal destruction. Such pathological process may result in apicomarginal defect along with inflammation of pulp. This creates challenging situation which clinician must be capable of performing advanced periodontal regenerative procedures for the successful management. This case report discusses clinical management of apicomarginal defect associated with extensive periradicular destruction in a maxillary lateral incisor, along with histopathologic aspect of the lesion.

Keyword

Apicomarginal communication; Guided tissue regeneration; Maxillary lateral incisor; Platelet rich plasma

MeSH Terms

Guided Tissue Regeneration
Incisor
Inflammation
Platelet-Rich Plasma
Tooth*

Figure

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  Figure 1 Labial view with draining sinus tract (yellow arrow) associated with maxillary right lateral incisor.

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  Figure 2 Palatal view (probing depth, 15 mm).

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  Figure 3 Preoperative intraoral periapical radiograph.

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  Figure 4 Preoperative cone beam computed tomography images. Green arrow indicates nonembeded pulp stone.

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  Figure 5 Reflection of mucoperiosteal flap.

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  Figure 6 After complete removal of granulation tissue. Yellow arrow indicates extrusion of approximately 1 mm of gutta-percha from the apex.

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  Figure 7 Mineral trioxide aggregate restoration after retropreparation.

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  Figure 8 Glass ionomer cement restoration in the palatoradicular groove. White arrow indicates glass ionomer restoration.

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  Figure 9 Bone defect filled with mixture of demineralized freeze-dried bone allograft and platelet rich fibrin.

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  Figure 10 Platelet rich fibrin used as membrane.

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  Figure 11 Suture to achieve primary closure.

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  Figure 12 Clinical photographs (a, b) and radiographs (c, d) at 12 month follow up. (a) Labial view; (b) Palatal view; (c) Intraoral periapical radiograph; (d) Cone beam computed tomography.

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  Figure 13 Photomicrograph of the lesion showing surface squamous epithelium with arcading type of proliferation (blue arrow) and chronic inflammatory cell infiltration in connective tissue (Haematoxylin and eosin stain, ×10).

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