Saving hopeless teeth - A retrospective case series with up to 10 years of follow-up

Abstract

Background: A one-rooted tooth in periodontal disease has hopeless prognosis due to significant bone loss horizontally or vertically, attachment loss to the apex, and hypermobility. Reconstructive treatment which closes periodontal pocket of hopeless teeth with continues craters to the apex can improve long-term prognosis for hopeless teeth. Description of the procedure: A retrospective study reviewed treatment of 9 patients presenting perioendo lesions. Endodontic treatment was conducted in accordance with a set of guidelines before surgical treatment. The patients received initial non-surgical periodontal therapy, including subgingival root debridement, followed by open flap debridement, apical root resection, and applying allogenic bone substitute (ABS) material after 1–6 months. Clinical attachment level (CAL), radiographic bone level (RBL) and periodontal probing depth (PPD) measurements were applied as main outcomes. Outcomes: 9 patients (5:4 F:M, Mage 53.00 ± 11.27 years, Stage 4, Grade B/C) and 9 teeth (6 lower incisors, 2 lower canines and 1 upper premolar) with perioendo lesions (mean PD 9.67 ± 1.23 mm) were included. At surgical treatment access flap (4 patients, 44.4%), non-incised papillae trapezoidal flap (4 patients, 44.4%) in keratinized gingiva or entire papilla preservation technique (1 patient, 11.1%) were performed with apical root resection, ABS application (8 patients,88.9%) and postoperative antibiotic treatment. The mean follow-uptime was 44.22 ± 35.58 months after surgery (min. 3, max. 112). Seven patients (77.8%) healed without complications, 2 (22.2%)healed by secondary intention. Clinically significant tooth morbidity reduction, average CAL gains (mean 6.32 ± 2.25 mm), RBL gain (mean7.12 ± 2.90 mm) and PPD reduction (mean 6.92 ± 2.61 mm) were observed in all 9 cases 6 months after surgery. All treated teeth still function: 3 (33.3%) are splinted, 6 (66.7%) on their own. Conclusions: Reconstructive treatment in closed periodontal pocket definition can improve long-term prognosis for hopeless teeth.