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Root amputation and perio-esthetics in salvaging a premolar.

Agarwal S, Saxena A, Chaubey KK, Agarwal M - J Indian Soc Periodontol (2015 Jul-Aug)

Bottom Line: Though, the tooth no. 14 was having Grade-I mobility, it was endodontically treated, buccal root was resected, osseous graft was applied over the deficient ridge area and lateral pedicle flap was displaced over the short root-trunk area to cover the surgical site.To our astonishment, the tooth survived, mobility was reduced and complete coverage with soft-tissue was observed.Uneventful healing with stable gingival margin was observed at 3-month interval, which remained stationary at 1-year follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Periodontics, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India.

ABSTRACT
A 32-year-old patient with complete denudation of buccal root of tooth no. 14 was referred from the Department of Oral Surgery for opinion, as he was not willing for extraction. Patient's persistent urge to save the tooth, put forth a challenge, which motivated us to tweak the established techniques. The unusual presentation of the case and unexpected par-operative condition of the surgical site required out-of-box measures to deal with the situation. Though, the tooth no. 14 was having Grade-I mobility, it was endodontically treated, buccal root was resected, osseous graft was applied over the deficient ridge area and lateral pedicle flap was displaced over the short root-trunk area to cover the surgical site. To our astonishment, the tooth survived, mobility was reduced and complete coverage with soft-tissue was observed. Uneventful healing with stable gingival margin was observed at 3-month interval, which remained stationary at 1-year follow-up.

No MeSH data available.


Exposed gutta-percha after root resection
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Figure 3: Exposed gutta-percha after root resection

Mentions: Obviously, the affected tooth had a completely denuded and prominent buccal root, which could hinder the treatment outcome. Hence, the buccal root was resected using a tapered fissure bur at the furcation level obliquely [Figures 2 and 3]. The obturated gutta-percha was visible on resected root-end near the furcation. 2 mm of gutta-percha was removed from the cut end, and it was sealed with a layer of glass-ionomer-cement (GIC) [Figure 4]. Almost two-third of the buccal aspect of the palatal root was visible. Its apical-third and palatal aspect were still embedded within bone and probably this was the reason for Grade-I mobility despite extensive bone-loss. Subsequently, lateral pedicle flap from the adjacent premolar, along with bone graft, was planned. De-epithelization of the mesial papilla of no. 14 was done using a no. 15 blade and recipient bed were prepared. After trans-gingival probing over buccal attached gingiva to rule out dehiscence/fenestration, sub-marginal incision was made leaving 2 mm of the gingival margin in the second premolar using a no. 11 blade [Figure 5]. Vertical incision along the distal line angle of the second premolar was then taken taking into consideration that the width of reflected flap was one and a half times wider than that of the recession. Full thickness flap was than raised up to mucogingival junction, followed by raising of partial thickness flap beyond the mucogingival junction to achieve coverage by flap without tension [Figure 6]. Synthetic bone graft, RTR (Septodont, 94107 Saint-Maur-des-Fosses Cedex, France) was placed, to fill the depression after root-resection [Figure 7]. Flap was than displaced laterally and carefully stabilized with interrupted and stabilizing nonresorbable sutures [Ethicon 5-0; Johnson and Johnson, India.] [Figure 8].


Root amputation and perio-esthetics in salvaging a premolar.

Agarwal S, Saxena A, Chaubey KK, Agarwal M - J Indian Soc Periodontol (2015 Jul-Aug)

Exposed gutta-percha after root resection
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4555806&req=5

Figure 3: Exposed gutta-percha after root resection
Mentions: Obviously, the affected tooth had a completely denuded and prominent buccal root, which could hinder the treatment outcome. Hence, the buccal root was resected using a tapered fissure bur at the furcation level obliquely [Figures 2 and 3]. The obturated gutta-percha was visible on resected root-end near the furcation. 2 mm of gutta-percha was removed from the cut end, and it was sealed with a layer of glass-ionomer-cement (GIC) [Figure 4]. Almost two-third of the buccal aspect of the palatal root was visible. Its apical-third and palatal aspect were still embedded within bone and probably this was the reason for Grade-I mobility despite extensive bone-loss. Subsequently, lateral pedicle flap from the adjacent premolar, along with bone graft, was planned. De-epithelization of the mesial papilla of no. 14 was done using a no. 15 blade and recipient bed were prepared. After trans-gingival probing over buccal attached gingiva to rule out dehiscence/fenestration, sub-marginal incision was made leaving 2 mm of the gingival margin in the second premolar using a no. 11 blade [Figure 5]. Vertical incision along the distal line angle of the second premolar was then taken taking into consideration that the width of reflected flap was one and a half times wider than that of the recession. Full thickness flap was than raised up to mucogingival junction, followed by raising of partial thickness flap beyond the mucogingival junction to achieve coverage by flap without tension [Figure 6]. Synthetic bone graft, RTR (Septodont, 94107 Saint-Maur-des-Fosses Cedex, France) was placed, to fill the depression after root-resection [Figure 7]. Flap was than displaced laterally and carefully stabilized with interrupted and stabilizing nonresorbable sutures [Ethicon 5-0; Johnson and Johnson, India.] [Figure 8].

Bottom Line: Though, the tooth no. 14 was having Grade-I mobility, it was endodontically treated, buccal root was resected, osseous graft was applied over the deficient ridge area and lateral pedicle flap was displaced over the short root-trunk area to cover the surgical site.To our astonishment, the tooth survived, mobility was reduced and complete coverage with soft-tissue was observed.Uneventful healing with stable gingival margin was observed at 3-month interval, which remained stationary at 1-year follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Periodontics, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India.

ABSTRACT
A 32-year-old patient with complete denudation of buccal root of tooth no. 14 was referred from the Department of Oral Surgery for opinion, as he was not willing for extraction. Patient's persistent urge to save the tooth, put forth a challenge, which motivated us to tweak the established techniques. The unusual presentation of the case and unexpected par-operative condition of the surgical site required out-of-box measures to deal with the situation. Though, the tooth no. 14 was having Grade-I mobility, it was endodontically treated, buccal root was resected, osseous graft was applied over the deficient ridge area and lateral pedicle flap was displaced over the short root-trunk area to cover the surgical site. To our astonishment, the tooth survived, mobility was reduced and complete coverage with soft-tissue was observed. Uneventful healing with stable gingival margin was observed at 3-month interval, which remained stationary at 1-year follow-up.

No MeSH data available.