Management and Histobacteriological Findings of Mucosal Fenestration: A Report of 2 Cases

Surgical management of a lateral lesion refractory to root canal retreatment caused by an extraradicular calculus. A case report

This article describes the management of a root canal-treated maxillary central incisor displaying a radiographic lateral radiolucency and a sinus tract that persisted irrespective of root canal retreatment following high standards. Endodontic microsurgery was indicated and curettage of the pathologic tissue revealed a calculus-like material attached to the outer root surface around the exit of a large lateral canal. A non-conventional approach was chosen: No root-end resection was conducted. Instead, the calculus was removed and the apical surface was scaled and smoothed, conserving the apical structure. Retrocavities were prepared in both lateral and apical foramens and filled with a bioceramic material. Follow-up examination showed optimal soft tissue healing. One-year follow-up of radiographs revealed healing of the lateral lesion. The lesion was diagnosed as a cyst, with an infected lumen. An exuberant calculus-like material attached to the external root surface was the most likely cause of the recalcitrant lateral periradicular lesion.

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.

Retrospective Study of Intentional Replantation for Type Ⅲb Dens Invaginatus with Periapical Lesions

INTRODUCTION

In recent years intentional replantation (IR) has received more attention for its high tooth survival rate and wide range of indications. Type Ⅲb dens invaginatus (DI) is one of the most serious types of tooth malformation and is very challenging to treat. When root-end surgery is not feasible, IR may be considered as an alternative to extraction. However, there is little information available on the use of IR for type Ⅲb DI. Therefore, this study investigated the treatment outcomes and clinical procedures used for treatment of type IIIb DI with IR.

METHODS

IR was performed to treat 10 patients with type Ⅲb DI with periapical lesions. Each tooth was examined clinically and radiologically. IR was selected by these patients as their treatment plan after treatment procedures were discussed. An experienced endodontist and an experienced surgeon performed all treatments using the same protocol and surgical technique. Postoperative assessments were comprised of clinical and radiographic examinations, tooth survival and functional status.

RESULTS

The follow-up period ranged from 4 to 39 months. After IR, eight teeth were functioning properly with no clinical and radiological signs of pathology. The other two teeth had complications after IR comprising recurrence of periapical radiolucency and sinus tract formation in one patient, and development of a mucosal fenestration in another. Both of these patients received additional surgery and showed marked improvements.

CONCLUSION

Our study evaluated the most clinical data to date and showed that IR may be a reliable alternative for type IIIb DI with a periapical lesion.

Successful management of a large mucosal fenestration at 18-months follow-up

OBJECTIVES

Mucosal fenestrations are infrequent and often challenging to treat depending on the extent of soft and hard tissue destruction. This article presents the successful management of a relatively larger mucosal fenestration associated with complete absence of buccal bone plate in a mandibular incisor secondary to trauma-induced periapical pathosis.

CLINICAL CONSIDERATIONS

After non-surgical endodontic therapy, surgery was performed for debridement of the osseous defect, root resection/shaping, connective tissue graft (CTG) placement on the affected root surface and platelet rich fibrin (PRF) in periapical osseous defect rather than use of bone graft and/or barrier membrane. Healing was uneventful, however, a small mucosal defect remained at 2 weeks follow-up. After 3 months of primary surgery, a corrective surgery was performed utilizing an "incision-free" approach i.e. tunnel technique with CTG in contrast to the contemporary flap approach. At 18 months follow-up, complete closure of the mucosal defect with a thick gingival biotype, normal sulcus depth, and good esthetic outcome were achieved. No recurrence and any clinical signs of infection or inflammation were observed.

CONCLUSIONS

Based on the outcomes of present case, an early intervention utilizing the minimally invasive surgical therapy and autologous biomaterials may be considered a viable approach to treat such complex lesions.

CLINICAL SIGNIFICANCE

Endodontic therapy in combination with PRF and CTG appears to provide successful outcomes in treatment of a large mucosal fenestration with periapical osseous defect.

A regenerative approach using xenograft and PRF membrane in the management of muscosal fenestration in posterior maxilla - A rare case report

Mucosal fenestration is a rare entity wherein apex of the tooth is exposed in the oral cavity due to breakdown of the overlying bone and mucosa. This leads to accumulation of plaque and if left untreated can hamper the further prognosis of the tooth. Although there are few evidences regarding mucosal fenestrations in posterior region of maxilla, treatment of the same have been challenging for the clinicians. This case report describes the management of mucosal fenestrations in the posterior maxilla by regenerative periodontal flap surgical approach using xenograft (Osseograft) and platelet-rich fibrin membrane.

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.

PRICE 2020 guidelines for reporting case reports in Endodontics: explanation and elaboration

Case reports play a key role in showcasing new, unusual or rare disease(s), and the impact of newer therapeutic approaches or interventions. The Preferred Reporting Items for Case reports in Endodontics (PRICE) 2020 guidelines are being introduced exclusively for Endodontics by adapting and integrating the CAse REport (CARE) guidelines and Clinical and Laboratory Images in Publications principles. The PRICE 2020 guidelines have been developed to help authors improve the completeness, accuracy and transparency of case reports in Endodontics and thus enhance the standard of manuscripts submitted for publication. The aim of this document is to provide a comprehensive explanation for each item in the PRICE 2020 checklist along with examples from the literature that demonstrate compliance with these guidelines. This information will highlight the importance of each item and provide practical examples to help authors understand the necessity of providing comprehensive information when preparing case reports. A link to this PRICE 2020 explanation and elaboration document is available on the Preferred Reporting Items for study Designs in Endodontology website at http://www.pride-endodonticguidelines.org.