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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.

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Apical fenestration, a root exposure defect, can cause pain and infection. Successful management requires combined endodontic and periodontal treatments.

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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.