Root Amputation and Perio Esthetic Surgery

1. ROOT AMPUTATION AND PERIO
ESTHETICS IN SALVAGING A
PREMOLAR – A CASE REPORT
PRESENTED BY
Dr. AJINS CB

2. INTRODUCTION:
 Gingival recession is an intriguing and complex phenomenon and is
defined as exposure of the root surface due to the displacement of the
gingival margin apical to the cemento-enamel-junction.
 Its etiology is multifactorial like, plaque-induced inflammation, calculus,
iatrogenic restorations, trauma from improper oral hygiene practices,
tooth malpositions, high frenum, and uncontrolled orthodontic
movements

3. CASE REPORT:
 CHIEF COMPLAINT : A 32-year-old male patient complaint of bleeding and
receding gums throughout the mouth and recurrent pain with root
exposure in relation to upper right first premolar since last 8-9 months.
 PAST HISTORY : vigorous horizontal scrubbing brushing method,
progressive apical migration of the marginal gingiva in no. 14.

4.  CLINICAL EXAMINATION : generalized recession and mild to moderate
probing pocket depths (3-5 mm) could be appreciated. The tooth no. 14
exhibited complete exposure of the buccal root, loss of vitality (upon
electric pulp test), Grade III furcation involvement and Grade I mobility.

5. MANAGEMENT :
 Phase I therapy : scaling and root planning,
rolling method of brushing,
occlusal corrections
 Phase 2 therapy : endodontic treatment,
resection of buccal root and
perio-plastic surgery for coverage of partially visible
palatal root.

6.  The buccal root was resected using a tapered fissure bur at the furcation level
abliquely
 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)

7.  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 was done , then, sub-marginal incision was made
leaving 2 mm of the gingival margin in the second premolar using a no. 11
blade

8.  Vertical incision along the distal line angle of the second premolar was
then taken. 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

9.  Synthetic bone graft was placed, to fill the depression after root-resection
 Flap was than displaced laterally and carefully stabilized with interrupted and
stabilizing nonresorbable sutures

10.  Periodontal dressing was given over aluminium-foil on the site. The
patient was discharged with postoperative instructions and medications
and chlorhexidine mouth-wash twice daily for 10 days.
Postoperative after 10
days
Postoperative after 3 months Postoperative after 1
year

11. DISCUSSION:
In this case, a successful management of denuded buccal root of a
maxillary first premolar was possible with advanced perio-plastic
surgical procedures providing esthetic satisfaction and salvaging the
tooth that was the prime concern of the patient. Clinical results 1-year
postoperatively were conducive with no recession Thus, it can be
construed that with diligent design, perio-plastic surgery can be implied
to revamp the esthetics as well as banish the disease, even in the
furcationally involved premolar.

12. CONCLUSION:
 Esthetic surgery is performed to reshape the affected structures in order to
ameliorate the patient's appearance. The better understanding of the tissue
behavior and broader treatment modalities help in discovering cures for
situations, which were otherwise deemed to be impossible to treat before.
With the interdisciplinary treatment approach and perio-plastic surgery
the tooth which are usually extracted can now be saved.

13. REFERENCES:
Tugnait A, Clerehugh V. Gingival recession-its significance and management. J
Dent 2001;29:381-94. Back to cited text no. 1
Zucchelli G, Clauser C, De Sanctis M, Calandriello M. Mucogingival versus
guided tissue regeneration procedures in the treatment of deep recession
type defects. J Periodontol 1998;69:138-45. Back to cited text no. 2