Autologous platelet-rich derivatives along with alloplastic bone substitute in the management of complex perio-endo cases

Abstract

Combined endodontic periodontal lesion is one of the most challenging dental conditions as making a definite diagnosis and henceforth treatment plan is a daunting task. The prognosis of complex lesion involving both endodontic and periodontic components is complex, but success rate can be improved with regenerative therapies. However, there is paucity of literature regarding its effectiveness in the clinical scenario as only few case reports have been documented in literature for the use of platelet-rich derivatives in regenerative osseous surgery requiring both endodontic and periodontal treatment. We are hereby presenting three cases requiring both endo and perio treatment. The first two cases involve mandibular first molar and maxillary first molar, respectively. The third case involves maxillary central incisor. In all the cases, first, endodontic treatment was initiated, then open flap curettage along with alloplastic bone substitutes was done. Platelet-rich fibrin and platelet-rich plasma were used along with. Three of the treated cases showed significant improvement radiographically and clinically. There was gain in clinical attachment, reduction in probing depth, and radiographic bone fill. Autologous platelet-rich derivative can be used in combination with alloplastic bone substitute for the management of endo-perio cases. Further long-term studies are needed to explore the clinical effectiveness of platelet-rich derivatives and predicting the probability of success of periodontal therapy.

Keywords: Bone graft; bone regeneration; furcation; root canal.

Figure 1

(a) Preoperative view showing furcation defect with respect to 46 at the time working length estimation, (b) preoperative involvement. Intraoral periapical radiograph showing furcal and periapical radiolucency with respect to 46 after root canal therapy, (c) intraoperative view showing probing depth at furcation area, (d) open flap curettage and placement of graft, (e) platelet-rich fibrin, (f) Placement of platelet-rich fibrin, (g) 18-month postoperatively, (h) 36-month postoperatively

Figure 2

(a) Preoperative involvement. Intraoral periapical radiograph showing furcal radiolucency with respect to 16, (b) intraoperative view showing furcation defect with respect to 16, (c) open flap curettage and placement of graft, (d) placement of platelet-rich fibrin, (e) radiograph after 12 months

Figure 3

(a) Preoperative labial view showing 13 mm probing depth mesial side of 11, (b) preoperative radiograph showing incomplete obturation with respect to 11, (c) papilla preservation flap, curettage, and debridement, (d) placement of graft with platelet-rich plasma, (e) 3 months after re-root canal treatment, (f) after regenerative periodontal therapy, (g) 2-year postoperative showing complete bone fill