Management of Isolated Labial Mucosal Fenestration by Endodontic Microsurgery Along With Platelet-Rich Fibrin and Connective Tissue Graft: A Series 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 the 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 the complete coverage of the mucosal fenestration with no post-operative complications and were followed up to 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.

A retrospective analysis of mandibular fractures in Mewat, India.

OBJECTIVES: Mandibular fractures vary significantly with respect to epidemiological and demographic parameters among populations. To date, no study has evaluated these aspects of mandibular fractures in Nuh, Mewat, Haryana, India. To retrospectively analyze the incidence, age and sex distributions, etiology, anatomic distribution, occlusal status, treatment modality provided, and their correlation in patients who suffered isolated mandibular fractures. MATERIALS AND METHODS: The records of maxillofacial injury patients who reported to the Department of Dentistry, SHKM Government Medical College from January 2013 to December 2019, were retrieved from our database, and necessary information was collected. The data collected were analyzed statistically using IBM SPSS ver. 21. RESULTS: Totals of 146 patients and 211 fractures were analyzed. There were 127 males and 19 females with an age range of 3-70 years (mean age, 26 years). Road traffic accident (RTA) was the most common cause of fracture (64.4%), followed by fall (19.9%), assault (15.1%), and sports injury (0.7%). Of all patients, 42.5% had bilateral fractures, 31.5% had left side fracture, 21.2% had right side fracture, 3.4% sustained midline symphyseal fracture, and 1.4% had symphyseal fracture along one side of the mandible. Site distribution was as follows: parasymphysis (34.6%), angle (23.7%), condyle (20.4%), body (12.8%), symphysis (4.3%), ramus 2.4%, and dentoalveolar 1.9%. The most common facture combination was angle with parasymphysis (17.8%). Occlusion was disrupted in 69.2% patients. Closed reduction was the predominant treatment modality. CONCLUSION: The data obtained from retrospective analyses of maxillofacial trauma increase the understanding of variables and their outcomes among populations. The results of the present study are comparable to those of the literature in some aspects and different in others.

Retrieval of Extruded Mineral Trioxide Aggregate Using a Novel Suction Device.

Treatment of necrotic immature permanent teeth is an exigently demanding situation for an endodontist. Regenerative endodontic procedures are being employed for such teeth in a hope to restore a functional pulp tissue and continue root development. However, currently advocated techniques may not be effective in retaining mineral trioxide aggregate (MTA) in its coronal position. The present paper describes two immature teeth with pulpal necrosis and apical periodontitis that were treated through revascularization. In both the cases, apical extrusion of the coronal MTA plug occurred. A suction tip was customized to completely retrieve the extruded material. Both cases proved out to be a clinical and radiographic success over extended follow-up periods.

Effect of Platelet-rich Fibrin on Healing of Apicomarginal Defects: A Randomized Controlled Trial.

INTRODUCTION: The purpose of this prospective, randomized controlled trial was to evaluate the healing outcomes of platelet-rich fibrin (PRF) in periapical surgeries involving apicomarginal defects and to compare these results with surgeries not using any guided tissue regeneration techniques. METHODS: Thirty patients with suppurative chronic apical periodontitis and apicomarginal communication were randomly assigned to either the PRF or the control group. Clinical and radiographic parameters including pocket depth (PD), clinical attachment level, gingival marginal position, size of periapical lesion, and percentage reduction of the periapical radiolucency were recorded at baseline and at an interval of 3 months for a period of 12 months. RESULTS: The overall success rate was 83.33%, with a success rate of 86.66% (13 of 15 teeth) for PRF group and 80% (12 of 15 teeth) for control group. Both the groups exhibited a significant reduction in PD, clinical attachment level, gingival marginal position, and size of periapical lesion at 12-month period. No significant differences were observed between the 2 groups for these parameters except PD, which showed a statistically significant reduction in the PRF group (P < .05). CONCLUSIONS: The adjunctive use of regenerative techniques may not promote healing of apicomarginal defects of endodontic origin.