Gingivo-osseous pathologic fenestration

Management of Isolated Labial Mucosal Fenestration by Endodontic Microsurgery Along With Platelet-Rich Fibrin and Connective Tissue Graft: A Report of Four Cases

INTRODUCTION

The purpose of this case report is to present endodontic and periodontal management of mucosal fenestrations with exposed root apices. The treatment protocol in present cases includes a combination of regenerative therapy using platelet-rich fibrin (PRF) with connective tissue graft (CTG) and endodontic microsurgery. Pre-existing condition of these teeth exhibits apical lesion with prominent root position and complete buccal bone dehiscence/fenestration presents a true challenge to successful outcome.

CASE PRESENTATION

Four patients having concomitant mucosal fenestrations with an apical lesion and complete denudation/fenestration of buccal plate were treated with root canal treatment and then by endodontic microsurgery. After the root-end resection and retrograde filling, PRF was placed in the bone defect maintaining intimate contact with the bone surface. CTG was harvested from the palate, placed over the PRF, and beneath the flap corresponding to the mucosal fenestration defect, and sutured with the flap to ensure a secured position. The flap was then repositioned and sutured. All patients showed complete coverage of the mucosal fenestration with no post-operative complications and were followed upto 2-5 years.

CONCLUSION

Peri-radicular endodontic microsurgery and CTG along with PRF may be used as a predictable treatment option to manage the mucosal fenestrations in such challenging cases. This article is protected by copyright. All rights reserved.

Diagnosis and Management of Apical Fenestrations Associated with Endodontic Diseases: A Literature Review

Apical fenestration describes a window-like opening of the alveolar bone that involves the root apex of the associated tooth. Mucosal fenestration is a similar defect of the overlying mucosa and, when presented with a concomitant apical fenestration, may expose the root apex to the oral environment. A fenestration may arise from physiological and pathological processes. Although its presence does not necessitate treatment per se, these lesions have significant clinical implications when associated with endodontic diseases. Apical fenestrations associated with endodontic infections are relatively uncommon and can easily be overlooked or misdiagnosed. A thorough understanding of these lesions is key for timely diagnosis and successful management. The aim of this study was to review the epidemiology, aetiological factors, characteristics, management methods and potential outcomes of apical fenestrations associated with endodontic diseases. A search of online databases for relevant studies was conducted. With the inclusion of hand searched articles, 20 articles, consisting of case reports and series, were identified, and the key characteristics of each case were summarised. Apical fenestrations were found to be most commonly associated with maxillary teeth and almost always occur on the buccal aspect of the alveolar bone. Clinicians may consider the possibility of an apical fenestration with concurrent endodontic pathology when patients present with non-healing sinus tracts, exposed tooth apices and/or persistent pain after endodontic treatment, particularly on palpation and mastication. Clinical signs and symptoms can vary, hence cone-beam computed tomography is an important tool for diagnosis. The management involves surgically restoring a favourable anatomical configuration of the root apex in relation to the alveolar bony housing and may be combined with guided tissue regeneration and/or grafting procedures. Sloughing, reopening and infection are potential complications. The literature on apical fenestrations associated with endodontic diseases is limited, thus further research is needed to develop evidence-based guidelines for the diagnosis and management of these lesions.

Gingival Fenestration Management: A Rarefied Case Entity and Literature Review

Dehiscence and fenestration are commonly confronted alveolar defects. But the combined mucosal and alveolar fenestration is uncommonly reported in the literature as they less often cause pain, and in majority of the cases, only aesthetic complaint is present. This article highlights the case report of a 28-year-old female patient who presented with aesthetic concern about gingival/mucosal fenestration in her right lower central incisor. She had a history of surgical endodontic treatment in the same tooth. In this case, mucosal fenestration was treated with regenerative therapy using bioactive glass with platelet-rich fibrin and free connective tissue graft. The treatment resulted in excellent aesthetic outcome and satisfactory bone healing.

Osseo-gingival pathology as sequelae of dental trauma to the primary upper incisor: a case series

BACKGROUND

Osseo-gingival pathology (OGP) may be observed in traumatized primary teeth, and its knowledge is essential for treatment decision.

AIM

To describe the occurrence and treatment of OGP in traumatized primary upper incisors.

DESIGN

One examiner collected data from patients' charts of the Clinic of Trauma in Primary Teeth of the University of Sao Paulo. OGP was divided into apical fenestration (AF), total gingival recession (TGR), and partial gingival recession (PGR).

RESULTS

From 2516 charts, 61 patients (2.4%) presented 73 teeth with OGP (9.6% AF, 19.2% TGR and 71.2% PGR). OGP was observed in 63% of male and 43.8% of children aged 4-5 years old. Mean time between trauma and diagnosis was 15 months AF, 23.5 months TGR, and 7.5 months PGR. Periodontal trauma occurred in 86.3% of teeth with OGP. Pulp necrosis was observed in all cases of AF and 92.9% of TGR; however, 76.9% of PGR were vital. All teeth with AF and 85.7% of TGR were extracted, and 44.2% of PGR were monitored.

CONCLUSIONS

Osseo-gingival pathology has low occurrence in traumatized primary upper incisors. The treatment for AF and TGR is tooth extraction, and for PGR is tooth monitoring or extraction depending on the case severity.

Pyogenic granuloma subsequent to apical fenestration of a primary tooth

BACKGROUND

The authors present two case reports of patients exhibiting pyogenic granulomas in the maxillary labial mucosa, which were related to an apical fenestration of a primary incisor.

CASE DESCRIPTIONS

Several researchers have reported that the gingival wound and surrounding inflammatory tissue typically heal spontaneously after extraction of a fenestrated primary tooth. However, in the cases presented here, the gingival lesion did not heal after the fenestrated teeth were extracted.

CLINICAL IMPLICATIONS

After extracting fenestrated teeth, clinicians need to examine the labial area at a follow-up appointment to ensure that the gingival hyperplasia heals properly. The authors suggest performing curettage of the surrounding abnormal tissue at the time of the tooth extraction.

Interesting presentation of a retained upper deciduous incisor with apical fenestration

A case is described where intrusion of a primary incisor resulting in apical fenestration may have occurred secondary to occlusal forces. The effects on the permanent dentition and possible aetiological factors are discussed.