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Treating apical fenestration in a previously endodontically treated tooth
K S Rajesh1, Riza Farooq2, F Abdul Rajak1
1Department of Periodontology, Yenepoya Dental College, Yenepoya (Deemed to be University), Deralakatte, Karnataka, India.
Journal of Conservative Dentistry and Endodontics
|January 8, 2025
Summary
Apical fenestration, a root exposure defect, can cause pain and infection. Successful management requires combined endodontic and periodontal treatments.
Area of Science:
- Dentistry
- Endodontics
- Periodontics
Background:
- Apical fenestration involves a defect in the alveolar cortical plate, exposing the root without affecting the alveolar bone margin.
- This condition is often associated with trauma, periodontal disease, and orthodontic treatment, potentially leading to pain and endodontic infections.
- Management of mucosal fenestration typically requires a coordinated approach involving both endodontic and periodontal interventions.
Observation:
- A 44-year-old male presented with symptoms of apical fenestration and pain in the anterior maxilla.
- The patient had a history of trauma and prior inadequate root canal treatment, with an ill-fitting crown and an open apex with periapical radiolucency.
- The initial presentation indicated a complex case requiring comprehensive dental management.
Findings:
- Nonsurgical root canal therapy was performed, including scaling, root planing, and apexification using Biodentine.
- Obturation was completed with a bioceramic sealer.
- Despite endodontic treatment, persistent fenestration led to the need for periodontal surgery to address extruded materials and facilitate bone regeneration with an alloplastic graft.
Implications:
- This case highlights the importance of a multidisciplinary approach for managing complex apical fenestrations.
- Coordinated endodontic and periodontal treatment is crucial for achieving successful outcomes in such cases.
- Effective management strategies are essential for preserving tooth structure and function in patients with apical fenestrations.
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