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Journal of Oral Science & Rehabilitation Volume 2 | Issue 2/2016 39 B o n e b l o c k g r a f t t o t r e a t a p i c o m a r g i n a l d e f e c t Discussion Complete healing of periapical tissue after peri- apical surgery includes regeneration of the alve- olar bone, periodontal ligament and cementum.11 SeveralstudieshaveshownthatGTRappliedwith periapical surgery promotes healing of apical le- sions and improves the prognosis of the treat- ment.12–14 In a recent meta-analysis, Tsesis et al. observed that GTR improved the success rate of periapical surgery, particularly in large and through-and-through lesions, although the dif- ferenceswerenotstatisticallysignificant.15 How- ever, none of the studies included evaluated the prognosis of teeth with apicomarginal defects. Tissue regeneration in teeth with apicomarginal defects is not as predictable and there is no ver- ified treatment option.16 Only four clinical trials, none ofthem with control groups, were found in whichtheprognosisofperiapicalsurgeryinteeth with apicomarginallesionswas studied. Dietrich et al. grafted the defects with inorganic bovine bone material and a collagen membrane.17 After one year, the clinical and radiographic assess- ment demonstrated a success rate of82.6% and themedianprobingpocketdepthdecreasedfrom 9mm to 3mm. Three years later, Marín-Botero et al. found similar results in two study groups.9 In one group, a polyglactin 910 membrane was placedovertheapicomarginaldefect(n =15),and in the other group, a sliding periosteal graft was usedtocoverthedefect(n=15).Identicalsuccess rates of 87% were observed in both groups. Recently, the outcome of modern endodon- tic microsurgerywas evaluated by Kim et al. in a prospective study.5 They studied healing accor- ding to the type of lesion and observed a healing success rate of 73.7% for teeth with apicomar- ginaldefectstreatedwith calcium sulfate placed into the periradicular bony defect and a collagen membrane coveringthe denuded buccalsurface. Goyal et al. evaluated the use of platelet-rich plasma (PRP)forthetreatment ofapicomarginal Fig. 9 Fig. 11 Fig. 10 Fig. 9 Endoscopic image after cavity filling with MTA. Fig. 10 The bone block graft was fixed with an osteosynthesis screw to regenerate the buccal wall of the lateral incisor. Fig. 11 Clinical appearance at the three-year follow-up visit. Fig. 12 Periapical radiograph three years after surgery. Complete bone regeneration around the apexes was observed. Volume 2 | Issue 2/201639