Endodontic and Periodontal Treatment of Complete Buccal Root and Apex Exposition: A Challenging Case Report With 17 Months Follow-Up.

INTRODUCTION: This case report demonstrated a challenging clinical case addressed within a multidisciplinary approach to achieve its maintenance, even though had a poor prognosis. It was associated with the endodontic treatment with mucogingival techniques, including periodontal microsurgery and connective tissue graft. CASE PRESENTATION: A patient presented a deep gingival recession with the apex-exposed non-vital tooth with interproximal bone loss (RT2) and without mobility. The treatment involved an initial endodontic approach and periodontal therapy (scaling and root planing), microsurgical techniques with coronally advanced flap, root preparation with PrefGel (24% EDTA), enamel matrix derivatives (Emdogain), and connective tissue graft. As a clinical result, it was verified an increase of keratinized tissue width and gingival thickness, and root coverage (RC), reaching good esthetics and a stable result after 17 months. CONCLUSION: The correct diagnosis and technique selection may affect directly the outcome, especially in challenging cases. Even though there was a poor prognosis, an adequate treatment plan, patient cooperation, and technique mastery help to achieve a high level of RC, esthetic recovering, and successful outcome.

Clinical evaluation and biological understanding of the early step-by-step healing after periodontal microsurgery: A case report with PES analysis comparing initial and 31-day result.

Microsurgery has evolved, permitting faster vascularization and healing than macro-interventions, reducing tissue trauma and obtaining precise wound closure. Therefore, this study aimed to detail the initial healing steps after the periodontal microsurgical procedure. A -26 year-old female had a localized recession (anterior lower tooth, recession type1-), with the absence of local keratinized tissue width (KTW) and adjacent gingival thickness (GT)<1 mm. After oral prophylaxis and occlusal adjustments, the pink esthetic score was performed (5 points), followed by the microsurgery procedure. Prior to inserting the subepithelial connective tissue graft (SCTG), the epithelial layer was removed, and the root surface was biomodified. Two days postoperatively, it was possible to observe a white layer from the SCTG in the gingival margin, decreasing after 4 days. In 6 days, the sutures were removed; no graft and volume loss was observed. For 9 days, the volume was the maintenance. Nevertheless, there was a reduction in tissue volume in the facial zone. After 11 and 13 days, an improved healing process was found, whereas, after 16 days, it was possible to report stable tissues, which was confirmed after 31 days, with a significant GR reduction and an increase in KTW and GT. Moreover, the final pink esthetic score (PES) was 9. Microsurgery had a faster healing and predictable outcome, suggesting reduced trauma, which may allow a quicker suture removal without jeopardizing the outcomes.