Palatal fenestration after orthodontic treatment. Intermodal approach and evolution. A case report

Area of Science:

• Periodontics
• Orthodontics
• Endodontics

Background:

• A 15-year-old patient presented with dissatisfaction regarding upper right canine position post-orthodontic treatment.
• Previous surgical interventions for canine traction resulted in complications.

Observation:

• Generalized plaque-induced gingivitis was noted.
• Palatal fenestration of the upper right lateral incisor root (75% surface area) with suppuration and minimal attached gingiva.
• Buccal torque of the crown and radiological evidence of mild rhizolysis and bone loss adjacent to the lateral incisor.

Findings:

• An interdisciplinary approach involving endodontic treatment with Biodentine retrograde filling, orthodontic torque modification, and periodontal connective tissue grafting (Langer technique) was implemented.
• Post-treatment, orthodontic improvements were observed, followed by successful periodontal grafting.
• At 4 years, the patient was asymptomatic with complete fenestration closure and no suppuration.

Implications:

• This case highlights the efficacy of a multidisciplinary strategy in managing complex periodontal and orthodontic issues.
• Connective tissue grafting and orthodontic adjustments can effectively treat gingival recession and fenestration, improving long-term outcomes.
• Successful management restored both function and aesthetics, resolving complications from prior surgical procedures.