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| LETTER TO EDITOR |
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| Year : 2013 | Volume
: 3
| Issue : 3 | Page : 148 |
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Treatment strategies for regeneration in endo-perio lesion
Jothi M Varghese
Department of Periodontics, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka, India
| Date of Web Publication | 20-Nov-2013 |
Correspondence Address:
Jothi M Varghese
Department of Periodontics, Manipal College of Dental Sciences, Manipal University, Manipal 576 104, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1658-5984.121509
How to cite this article:
Varghese JM. Treatment strategies for regeneration in endo-perio lesion. Saudi Endod J 2013;3:148 |
Sir,
I read with keen interest an article titled, 'Retreatment and surgical repair of the apical third perforation and osseous defect using mineral trioxide aggregate, authored by Savitha A et al., which has been published in your esteemed journal (2013;3:34-8). I appreciate the author's attempts in furnishing details related to the successful management of a case with apical third perforation. Root perforations result in loss of integrity of both, root and destruction of periodontal tissues. A successful treatment outcome lies in reconstructing both the voids simultaneously and conclusively. Such reports provide clinicians to make predictable decisions while dealing with similar lesions.
I have a few queries to the author and also would like to share my suggestions to this particular case. First, initially the author describes the maxillary lateral incisor associated with iatrogenic apical third perforation as a one-walled osseous defect. On surgical reflection of a full thickness flap, it revealed a complete loss of buccal cortical plate and an intact palatal plate of bone. The pre-operative radiograph and surgical photograph reveals bone on mesial aspect of left lateral incisor still persistent. Hence, it seems to be more of a two-walled osseous defect. Secondly, although there is valuable literature pertaining to the benefits of MTA as a repair material [1] and its regenerative potential [2] reports regarding complete new bone regeneration using MTA are inconsistent. [3] These types of lesions with root perforation and osseous defect would provide better results, if bone grafts could be combined with the repair material. The osseous graft material provides a scaffold, which gradually gets resorbed providing an osteo-conductive effect, thus enhancing bone regeneration. [4] Third, since there was complete loss of buccal cortical plate, placement of a barrier membrane would have provided attempts to prevent down growth of epithelium during the healing phase, thus enhancing a new attachment. It is an accepted protocol that all inflammatory periapical/periodontal lesions should be initially treated with conservative non-surgical therapy. In this particular case, the authors have not mentioned if a non-surgical periodontal therapy consisting of root planning (periodontal pocket depth of more than 6 mm) was performed along with conservative endodontic therapy. This is an essential pre-requisite, especially in chronic cases with sinus, and also helps to reduce the inflammatory components substantially prior to surgical intervention. Fourth, long-standing lesions usually have a complex microbial niche, in such cases; prescribing combination antibiotic therapy would be more effective. Hence, along with Amoxicillin, a broad-spectrum antibiotic, Metronidazole (400 mg) would have been appropriate choice, because it has a wide anti-bacterial spectrum among anaerobes, [5] which are common species causing periodontal destruction.
| References | |  |
| 1. | Toranbinejad M, Chivian N. Clinical applications of mineral trioxide aggregate. J Endod 1999;25:197-205. 
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| 2. | Holland R, De Souza V, Nery MJ, Otoboni Filho JA, Bernabé PF, Dezan Júnior E. Reaction of rat connective tissue to implanted dentin tubes filled with mineral trioxide aggregate or calcium hydroxide. J Endod 1999;25:161-6.
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| 3. | Torreira GM, Dos Santos AA, Cobos R, Boquete F, Abelleira C. The osteoinductive potential of mineral trioxide aggregate. A histologic study in rabbits. Eur J Anat 2004;8:101-5.
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| 4. | Sreedevi P, Varghese N, Varugheese JM. Prognosis of periapical surgery using bonegrafts: A clinical study. J Conserv Dent 2011;14:68-72.
[PUBMED]  |
| 5. | Ingham HR, Seckon JB, Hale JH. The antibacterial activity of Metronidazole. J Antimicrob Chemothe 1975;1:355-61
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