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Dental Tribune United Kingdom Edition

17Perio TribuneFebruary 25- March 3, 2013United Kingdom Edition References: 1. Mellonig JT. Freeze dried bone allografts in periodontal reconstructive surgery. Dent Clin of North Am 1991;35:505-520. 2. Car- ranza FJ. Glickman‘s clinical periodontol- ogy. 1990; 7th edition. Philadelphia: WB Saunders Company. 3. Abrams H, Cun- ningham CJ, Lee SB. Periodontal changes following coronal/ root perforation and formocresol pulpotomy. Journal of Endo- dontics 1992;18:399–402. 4. Chen RJ, Yang JF, Chao TC. Invaginated tooth associated with periodontal abscess. Oral Surgery Oral Medicine Oral Pathology 1990;69:659- . 5. Kareha MJ, Rosenberg ES, DeHaven H. Therapeutic considerations in the man- agement of a periodontal abscess with an intrabony defect. Journal of Clinical Perio- dontology 1981;8:375–386. 6. Newman MG, Sims TN. The predominant cultivable mi- crobiota of the periodontal abscess. Journal of Periodontology 1979;50:350–354. 7. Yu- sof VZ, Ghazali MN. Multiple external root resorption. Journal of the American Dental Association 1989;118, 453–455. 8. Goose DH. Cracked tooth syndrome. British Den- tal Journal 1981;150:224– 225. 9. Rotstein I, Simon J. The endo-perio lesion:a critical ap- praisal of the disease condition. Endodontic topics 2006;13:34-56. 10. Blomlöf L, Leng- heden A, Lindskog S. Endodontic infection and calcium hydroxide treatment. Effects on periodontal healing in mature and im- mature replanted monkey teeth. Journal of Clinical Periodontology 1992;19:652-658. 11. Jansson L, Ehnevid H, Blomlöf L, Wein- traub A, Lindskog S. Endodontic pathogens in periodontal disease augmentation. J Clin Periodontol 1995;22:598-602. 12. Trombelli L, Heitz-Mayfield L, Needleman I, Moles D, Scabbia A. A systematic review of graft materials and biological agents for peri- odontal intraosseous defects. J Clin Peri- odontol 2002; 29:117–135. 13. Sculean A, Nikolidakis D, Schwarz F. Regeneration of periodontal tissues.Combinations of barri- er membranes and grafting materials – bio- logical foundation and preclinical evidence. A systematic review. J Clin Periodontol 2008; 35:106–116. 14. Herrera D, Roldan S, Sanz M. The periodontal abscess: a review. J Clin Periodontol. 2000;27:377-386. 15. Newman T, Klokkevold, Carranza FA. Clin- ical Periodontology. 10th ed. Philadelphia: Saunders;2006. 16. Simring M, Goldberg M. The pulpal pocket approach: retrograde periodontitis. J Periodontol.1964;35:22-48. and is more favourable for achieving new attachment. Therefore periodontal flap surgery along with bone graft placement lead to a more fa- vourable response in this case. Trombelli et al. (2002), in his systematic review stated that use of biomaterials/biologicals along with open flap debridement was more effective in improving at- tachment levels in intra-osseous defects. The morphology of the defect is an important factor that determines the outcome of the regenerative therapy. In this case, there was a combined two to three wall defect and a grade II furcation involvement which provides most predictive out- come of grafting procedures. The management of grade II furcation involvement presents a unique clinical problem. Rea- sons for compromised results in furcation areas include the lack of proper access for instru- mentation as well as for proper maintenance care due to the complex furcation anatomy and consequently a persistence of pathogenic microflora. The recent systematic review by Sculean et al. (2008) provides histological evidence of perio- dontal regeneration with the use of grafts and barrier membranes in combination. However, the combination of grafts and bar- rier membrane did not provide additional advantage in Grade II furcation and three wall defects. The space providing properties of the graft material proved to be useful in periodontal regenera- tion. In this case, barrier mem- brane was not used as the tissues were fragile and there was a risk of membrane exposure. Howev- er, satisfactory results have been obtained with FDBA as a bone graft material. Mineralised freeze dried bone allograft (FDBA) has osteo- conductive properties thus acts as a scaffold for bone formation. Extensive research has been done on FDBA as a graft mate- rial. Mellonig in 1991 found that at least 50 per cent bone fill in 67 per cent of periodontal defects and the percentage increased to 78 per cent if it was combined with autograft. In the present case, the lesion was primarily of periodontal ori- gin with secondary endodontic involvement. Therefore, the suc- cess of the treatment depended on the periodontal treatment. Satisfactory results were ob- tained after access flap surgery along with the use of FDBA. Conclusion: The endo-perio lesions have always been a diagnostic and prognostic dilemma. The treatment plan also varies de- pending upon the type of le- sion. Primary endodontic and periodontal lesions heal com- pletely by endodontic and peri- odontal therapy respectively. However, combined lesion often requires both endodontic and periodontal therapy. Proper di- agnosis, decision making and treatment plan can change the prognosis of such cases from hopeless to hopeful. DT About the author Dr.Sneha R. Gokhale-Gaikwad, MDS Specialist in Periodontics and Oral Im- plantology E-mail: gokhalesneha@yahoo.com 1.5HoursCPDPoints UPCOMING WEBINARS: 26/02/13 05/03/13 21/03/13 27/03/13 Short Term Orthodontics for the GDP Getting serious about Implantology with the ITI An Introduction to the uses of CEREC Technology for the GDP Perio Implant Interface - The Three P’s of Perio Over the last four years we have built a solid reputa- tion as the original and best dental webinar provider. The webinars are live and interactive to give a unique learning experience. Interact with some of the industry’s leading experts as they present the very latest in clinical practice. smile-on healthcarelearning inspiring better care Join the Dental Webinar club – sign up for free: www.dentalwebinars.co.uk