Regeneration after paraendodontic surgery in tooth with extensive bone fenestration - Case report with 3 years follow-up




Bone regeneration; Endodontics; Guided tissue regeneration; Osteogenesis; Retreatment.


This clinical case reports bone repair after paraendodontic surgery with the use of mineral trioxide aggregate (MTA) and guided tissue regeneration (GTR). The patient sought the Orthodontics Clinic at Faculdade COESP, showing disocclusion on element 11, grade II mobility. On radiographic examination, an apical radiolucency was observed, from the root of tooth 13 to 11, needing to be referred for endodontics. With a doubtful prognosis, it followed with endodontic retreatment and after 3 months the surgical intervention was performed. Then, the graft was accommodated in the bone store, followed by adaptation of the membrane and suture. After 6 months, there was no sensitivity to vertical percussion and palpation. After 3 years, new bone formation was observed in the periapical region, thus, it was concluded that the chosen method of disinfecting the environment and using a bone graft in addition to guided tissue regeneration promoted a satisfactory bone regeneration with the consequent maintenance of the dental element in the oral cavity.


Abbott, P. V. (2002). The Periapical Space - A Dynamic Interface. Australian Endodontic Journal, 28(3), 96–107. 10.1111/j.1747-4477.2002.tb00399.x

Alharmoodi, R., & Al-Salehi, S. (2019). Assessment of the quality of endodontic re-treatment and changes in periapical status on a postgraduate endodontic clinic. Journal of Dentistry, 103261. 10.1016/j.jdent.2019.103261

Aminozarbian, M. G., Barati, M., Salehi, I., & Mousavi, S. B. (2012). Biocompatibility of mineral trioxide aggregate and three new endodontic cements: an animal study. Dent Res J (Isfahan), 9, 54-9.

Brugnami, F., & Mellonig, J. T. (1999). Treatment of a large periapical lesion with loss of labial cortical plate using GTR: a case report. Int J Periodontics Restorative Dent, 19, 243–249.

Chen, G., Fang, C. T., & Tong, C. (2009). The management of mucosal fenestration: a report of two cases. Int Endod J, 42, 156-164.

Dahlin, C., Linde, A., Gottlow, J., & Nyman, S. (1988). Healing of bone defects by guided tissue regeneration. Plast Reconstr Surg, 81, 672–676.

Fernandez-Yanez Sanchez, A., Leco-Berrocal, M. I., Martinez-Gonzalez, J. M. (2008). Metaanalysis of filler materials in periapical surgery. Med Oral Patol Oral Cir Bucal, 13, E180–185.

Fezai, H., & Al-Salehi, S. (2019). The relationship between endodontic case complexity and treatment outcomes. Journal of dentistry, 85, 88-92.

Goyal, B., Tewari, S., Duhan, J., & Sehgal, P. K. (2011). Comparative Evaluation of Platelet-rich Plasma and Guided Tissue Regeneration Membrane in the Healing of Apicomarginal Defects: A Clinical Study. Journal of Endodontics, 37(6), 773–780. 10.1016/j.joen.2011.03.003 .

Hirsch, J. M., Ahlstrom, U., Henrikson, P. A., et al. (1979), Periapical surgery. Int J Oral Surg, 8:173–85

Kim, E., Song, J. S., Jung, I. Y., Lee, S. J., & Kim, S. (2008) Prospective clinical study evaluating endodontic microsurgery outcomes for cases with lesions of endodontic origin compared with cases with lesions of combined periodontal-endodontic origin. J Endod, 34(5):546-51.

Lieblich, S. E. (2012) Endodontic Surgery. Dental Clinics of North America 56, 121-132.

Lin, L., Chen, M. Y., & Ricucci, D. (2010). Guided tissue regeneration in periapical surgery. J Endod 36, 618–25.

Lin, L. M., Ricucci, D., & Lin, J., Rosenberg, P. A. (2009). Nonsurgical root canal therapy of large cyst-like inflammatory periapical lesions and inflammatory apical cysts. J Endod, 35, 607–15.

Lin, Y. C., Lee, Y. Y., Ho, Y. C., Hsieh, Y. C., Lai, Y. L., & Lee, S. Y. (2015). Treatment of Large Apical Lesions with Mucosal Fenestration: A Clinical Study with Long-term Evaluation. Journal of Endodontics, 41(4), 563–567. 10.1016/j.joen.2014.11.020

Loyola, M., Ancoski, T., Ramires, M. A., Mello, F., & Mello, A. M. D. (2018). Enxertos Ósseos Autógenos e Xenógenos como Alternativa de Manutenção do Espaço Alveolar. RGS, 19, 8-18.

Mellonig, J. T., & Nevins, M. (1995). Guided bone regeneration of bone defects associated with implants: an evidence-based outcome assessment. International Journal of Periodontics & Restorative Dentistry, 15(2).

Paknejad, M., Rokn, A., Rouzmeh, N., Heidari, M., Titidej, A., Kharazifard, M. J., & Mehrfard, A. (2015). Histologic evaluation of bone healing capacity following application of inorganic bovine bone and a new allograft material in rabbit calvaria. J. Dent. (Tehran), 12, 31–38.

Pecora, G., Kim, S., Celletti, R., & Davarpanah, M. (1995) The guided tissue regeneration principle in endodontic surgery: one-year postoperative results of large periapical lesions. Int Endod J, 28, 41–46.

Pereira, A. S., et al. (2018). Metodologia da pesquisa científica. UFSM.

Ruiz, P. A., Souza, A. H. F., Amorim, R., et al. (2003) Agregado de trióxido mineral (MTA): uma nova perspectiva em endodontia. Rev. bras. Odontol., 60(1), 33-35.

Serrano-Giménez, M., Sánchez-Torres, A., Gay-Escoda, C. (2015) Prognostic factors on periapical surgery: a systematic review. Med Oral Patol Oral Cir Bucal, 1, 20(6), e715-22.

Siqueira, J. F. Jr. (2005). Reaction of periradicular tissues to root canal treatment: benefits and drawbacks. Endod Topics, 10, 123-147.

Sood, N., Maheshwari, N., Gothi, R., & Sood, N. (2015). Treatment of large periapical cyst like lesion: A noninvasive approach: A report of two cases. Int J Clin Pediatr Dent, 8, 133–137

Taschieri, S., Del Fabbro, M., Francetti, L., Perondi, I., & Corbella, S. (2016). Does the Papilla Preservation Flap Technique Induce Soft Tissue Modifications over Time in Endodontic Surgery Procedures? Journal of Endodontics, 42(8), 1191–1195. 10.1016/j.joen.2016.05.003

Torabinejad, M., & Parirokh, M. (2010) Mineral trioxide aggregate: a comprehensive literature review–part II: leakage and biocompatibility investigations. Journal of Endodontics, 36, 190–202.

Versiani, M. A., Pércora, J. D., & Sousa-Neto, M. D. (2011) Flat-oval root canal preparation with self-adjusting file instrument: a micro-computed tomography study. Journal of Endodontics, 37, 1002-1007.

von Arx, T., & Kurt, B. (1999). Root-end cavity preparation after apicoectomy using a new type of sonic and diamond-surfaced retrotip: A 1-year follow-up study, Journal of Oral and Maxillofacial Surgery, 57, 6, 656-661.

von Arx, T., Penarrocha, M., & Jensen, S. (2010). Prognostic factors in apical surgery with rootend filling: a meta-analysis. J Endod, 36, 957–973.

Wang, W., & Yeung, K.W.K. (2017). Bone grafts and biomaterials substitutes for bone defect repair: A review. Bioact. Mater. 2, 224–247.



How to Cite

SILVA, S. de A.; LARANJEIRA, A. C. de S.; VELOZO, C. .; MONTENEGRO, L. de A. S.; BERNARDES , B. B. B. .; SANTOS , M. B. da S. .; ALBUQUERQUE, R. M. de; ALBUQUERQUE, D. S. de . Regeneration after paraendodontic surgery in tooth with extensive bone fenestration - Case report with 3 years follow-up. Research, Society and Development, [S. l.], v. 10, n. 4, p. e22210413983, 2021. DOI: 10.33448/rsd-v10i4.13983. Disponível em: Acesso em: 7 may. 2021.



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