Dr Chakravarthy Muppalla
Use of an amniotic membrane as a novel barrier in a tooth with a questionable prognosis
This case report describes a tooth with questionable prognosis treated successively by endodontic and periodontal therapy, using an AM with bone graft to treat an intrabony defect.
A 34-year-old female patient reported with a chief complaint of mobility and dull tooth pain in relation to 11. Patient gave a history of trauma to the maxillary region due to an accident, 2 months prior. Clinical examination showed inflammation extending till the attached gingiva and pain on percussion in relation to 11. It was supraerupted, with Grade II mobility and thick band of calculus. Probing pocket depth (PD) of 6 mm and clinical attachment loss (CAL) of 8 mm was seen in relation to 11. Radiographically, an intrabony defect with radiolucency in the mesiodistal region was seen. A positive response to percussion test suggested that the inflammation of periodontal ligament could be of pulpal or periodontal origin. Pulp sensitivity testing using pulse oximeter showed 11 to be vital.
Considering 11 was vital with Grade II mobility, the patient was advised root canal treatment (RCT) and splinting of the tooth followed by periodontal regenerative therapy
At the first appointment, periodontal parameters of PD, mobility, and radiographic assesment of bone loss were carried out. Full mouth scaling and root planing followed by oral hygiene instructions were given. Antibiotics (amoxicillin 500 mg thrice daily/5 days) and analgesics (Ibuprofen 400 mg thrice daily/3 days) were prescribed. The patient then underwent RCT of 11 and splinting was done consecutively (13–23) within a week. After reevaluation at 3rd month, periodontal regenerative therapy was initiated. After local anesthesia, a Bard-Parker No. 15 blade was used in relation to 13–23 to make the crevicular incisions. A full-thickness flap was raised, defect debridement, and thorough root planing were done. The defect was filled using the bone graft (Periobone-G) The AM was trimmed and tucked underneath the flap margins, allowing it to adapt to and cover the defect and interproximal area. This AM upon contact with tissue fluid, develops advantageous self-adhering properties and was placed without shrivelling. The mucoperiosteal flap was repositioned and sutured
Postsurgical instructions were given; systemic antibiotics and analgesics were also prescribed. The patient was given instructions to rinse everyday with a 0.2% chlorhexidine solution for 7 days. The patient was recalled for appointments which were scheduled once in 10 days for the 1st month, and later at the 9th and 12th month.
After 10 days, the sutures were removed, and healing was found to be satisfactory. When the patient was revealuated at the 9th and 12th month radiographic bone fill and soft tissue healing was detected. The probing depth had reduced from 6 to 3 mm Periapical radiographs taken postoperatively at the 9th and 12th month indicated radiographic bone fill in relation to 11
1-preoperative view in relation to 11
1a-preoperative radiograph
2-Splinting done in relaiton to 13 to 23
3-Flap Reflected (Presutured) Bonegraft (Periobone-G)
4-amniotic membrane
5-Amniotic membrane placed in relation to 11
sutures placed
Obturation in relation to 11
postoperative radiograph after 9 months
postoperative radiograph after 12 months
twelfth month postoperative
