Sidiropoulos Konstantinosa, Roussou Konstantinaa, Intzes Lambrosb, Economides Nikolaosb
aAristotle University of Thessaloniki, School of Dentistry, Thessaloniki, Greece
bAristotle University of Thessaloniki, School of Dentistry, Department of Endodontology, Thessaloniki, Greece
Summary
Background/Aim: Guided tissue regeneration is widely used in endodontic surgery. The aim is to aid in the healing process and bone regeneration and provide more successful and predictable outcomes. Case report: This case report describes the successful treatment of an endodontic-periodontal lesion (with primary endodontic involvement), including root canal retreatment and endodontic surgery with the use of GTR (collagen absorbable membrane-xenogeneic bone graft). CBCT examination was used to aid in diagnosis and in the follow-up examination after two years to provide additional confirmation of the healing process. An extensive literature review was undertaken focusing on clinical studies that assessing the added benefit of GTR in surgical endodontics. The clinical and radiographic examinations showed uneventful healing and the reconstruction of the buccal plate and periapical area. The patient remained asymptomatic throughout the entire two years period after surgical intervention. A literature review concluded that lesion type, lesion size and the selection of the biomaterial are important factors that influence the outcome of GTR in comparison control groups. A favorable outcome was found in cases of large periapical lesions (>10mm), through-through lesions and with the use of an absorbable membrane, with or without a bone graft. Conclusions: GTR is thought to provide an added benefit in bone regeneration and the healing process in specific cases. The outcomes in the case report are consistent with the conclusions of literature review.
Keywords: endodontic surgery; guided tissue regeneration; membranes; bone grafts
Reference
Andreasen, J.O., Rud, J. (1972) Modes of healing histologically after endodontic surgery in 70 cases. Int J Oral Surg, 1(3), 148-160
Apaydin, E.S., Torabinejad, M. (2004) The effect of calcium sulfate on hard-tissue healing after periradicular surgery. Journal of Endodontics, 30(1), 17-20
Artzi, Z., Wasersprung, N., Weinreb, M., Steigmann, M., Prasad, H.S., Tsesis, I. (2012) Effect of guided tissue regeneration on newly formed bone and cementum in periapical tissue healing after endodontic surgery: An in vivo study in the cat. Journal of Endodontics, 38(2), 163-169
Bansal, R., Jain, A., Mittal, S., Kumar, T., Kaur, D. (2014) Regenerative endodontics: A road less travelled. Journal of clinical and diagnostic research, 8, 20-24
Bashutski, J.D., Wang, H.L. (2009) Periodontal and endodontic regeneration. Journal of Endodontics, 35(3), 321-328
Bergenholtz, G., Wikesjö, U.M.E., Sorensen, R.G., Xiropaidis, A.V., Wozney, J.M. (2006) Observations on healing following endodontic surgery in nonhuman primates (Macaca fascicularis): Effects of rhBMP-2. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 101(1), 116-125
Bernabé, P.F., Gomes-Filho, J.E., Cintra, L.T., Moretto, M.J., Lodi, C.S., Nery, M.J., et al. (2010) Histologic evaluation of the use of membrane, bone graft, and MTA in apical surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 109, 309-314
Boccaccini, A.R., Blaker, J.J. (2005) Bioactive composite materials for tissue engineering scaffolds. Expert Review of Medical Devices, 2(3), 303-317
Britain, S.K., von Arx, T., Schenk, R.K., Buser, D., Nummikoski, P., Cochran, D.L. (2005) The use of guided tissue regeneration principles in endodontic surgery for induced chronic periodontic-endodontic lesions: A clinical, radiographic, and histologic evaluation. Journal of Periodontology, 76(3), 450-460
Brown, P., Rau, E.H., Johnson, B.K., Bacote, A.E., Gibbs, C.J., Gajdusek, D.C. (2000) New studies on the heat resistance of hamster-adapted scrapie agent: Threshold survival after ashing at 600 C suggests an inorganic template of replication. Proceedings of the National Academy of Sciences, 97(7), 3418-3421
Dietrich, T., Zunker, P., Dietrich, D., Bernimoulin, J.P. (2003) Periapical and periodontal healing after osseous grafting and guided tissue regeneration treatment of apicomarginal defects in periradicular surgery: Results after 12 months. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 95(4), 474-482
Dominiak, M., Lysiak-Drwal, K., Gedrange, T., Zietek, M., Gerber, H. (2009) Efficacy of healing process of bone defects after apicectomy: Results after 6 and 12 months. J Physiol Pharmacol, 60, 51-55
Douthitt, J.C., Gutmann, J.L., Witherspoon, D.E. (2001) Histologic assessment of healing after the use of a bioresorbable membrane in the management of buccal bone loss concomitant with periradicular surgery. Journal of Endodontics, 27(6), 404-410
Garrett, K., Kerr, M., Hartwell, G., Osullivan, S., Mayer, P. (2002) The effect of a bioresorbable matrix barrier in endodontic surgery on the rate of periapical healing: An in vivo study. Journal of Endodontics, 28(7), 503-506
Ghanaati, S., Barbeck, M., Booms, P., Lorenz, J., Kirkpatrick, C.J., Sader, R.A. (2014) Potential lack of ‘standardized’ processing techniques for production of allogeneic and xenogeneic bone blocks for application in humans. Acta Biomaterialia, 10(8), 3557-3562
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
Grzesik, W.J., Narayanan, A.S. (2002) Cementum and periodontal wound healing and regeneration. Crit Rev Oral Biol Med, 13(6), 474-484
Gurtner, G.C., Werner, S., Barrandon, Y., Longaker, M.T. (2008) Wound repair and regeneration. Natur, 453, 314-321
Gutmann, J.L., Harrison, J.W. (1985) Posterior endodontic surgery: Anatomical considerations and clinical techniques. International endodontic journal, 18(1), 8-34
Hirsch, J.M., Ahlström, U., Henrikson, P.A., Heyden, G., Peterson, L.E. (1979) Periapical surgery. International Journal of Oral Surgery, 8(3), 173-185
Krtolica, A. (2005) Stem cell: Balancing aging and cancer. Int J Biochem Cell Biol, 37, 935-941
Lin, L., Chen, M.Y.H., Ricucci, D., Rosenberg, P.A. (2010) Guided tissue regeneration in periapical surgery. J Endod, 36, 618-625
Marin-Botero, M.L., Dominguez-Mejia, J.S., Arismendi-Echavarria, J.A., Mesa-Jaramillo, A.L., Florez-Moreno, G.A., Tobon-Arroyave, S.I. (2006) Healing response of apicomarginal defects to two guided tissue regeneration techniques in periradicular surgery: A double-blind, randomized-clinical trial. International Endodontic Journal, 39(5), 368-377
Melcher, A.H. (1976) On the repair potential of periodontal tissues. Journal of Periodontology, 47(5), 256-260
Murashima, Y., Yoshikawa, G., Wadachi, R., Sawada, N., Suda, H. (2002) Calcium sulphate as a bone substitute for various osseous defects in conjunction with apicectomy. International Endodontic Journal, 35(9), 768-774
Murugan, R., Rao, K., Sampath, K.T.S. (2003) Heat-deproteinated xenogeneic bone from slaughterhouse waste: Physico-chemical properties. Bulletin of Materials Science, 26(5), 523-528
Nakashima, M., Akamine, A. (2005) The application of tissue engineering to regeneration of pulp and dentin in endodontics. Journal of Endodontics, 31(10), 711-718
Pecora, G., de Leonardis, D., Ibrahim, N., Bovi, M.N., Cornelini, R. (2001) The use of calcium sulphate in the surgical treatment of a ‘through and through’ periradicular lesion. International Endodontic Journal, 34(3), 189-197
Pecora, G., Andreana, S., Margarone, J.E., Covani, U., Sottosanti, J.S. (1997) Bone regeneration with a calcium sulfate barrier. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 84(4), 424-429
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. International Endodontic Journal, 28(1), 41-46
Rankow, H.J., Krasner, P.R. (1996) Endodontic applications of guided tissue regeneration in endodontic surgery. Journal of Endodontics, 22(1), 34-43
Ricucci, D., Russo, J., Rutberg, M., Burleson, J.A., Spångberg, L.S. (2011) A prospective cohort study of endodontic treatments of 1,369 root canals: results after 5 years. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 112, 825-842
Ruch, J.V., Lesot, H., Karcher-Djuricic, V., Meyer, J.M., Olive, M. (1982) Facts and hypotheses concerning the control of odontoblast differentiation. Differentiation, 21(1-3), 7-12
Saad, Y.A., El-Said, A.M.M. (1991) Healing assessment of osseous defects of periapical lesions associated with failed endodontically treated teeth with use of freeze-dried bone allograft. Oral Surgery, Oral Medicine, Oral Pathology, 71(5), 612-617
Schwarz, F., Mihatovic, I., Ghanaati, S., Becker, J. (2017) Performance and safety of collagenated xenogeneic bone block for lateral alveolar ridge augmentation and staged implant placement: A monocenter, prospective single-arm clinical study. Clinical Oral Implants Research, 28(8), 954-960
Seidel, P., Dingeldein, E. (2004) Cerabone®eine Spongiosa-Keramik bovinen Ursprungs. Materialwissenschaft und Werkstofftechnik, 35(4), 208-212
Skoglund, A., Persson, G. (1985) A follow-up study of apicoectomized teeth with total loss of the buccal bone plate. Oral Surg Oral Med Oral Pathol, 9, 78-81
Tadic, D., Epple, M. (2004) A thorough physicochemical characterisation of 14 calcium phosphate-based bone substitution materials in comparison to natural bone. Biomaterials, 25(6), 987-994
Taschieri, S., Fabbro, D.M., Testori, T., Saita, M., Weinstein, R. (2008) Efficacy of guided tissue regeneration in the management of through-and-through lesions following surgical endodontics: A preliminary study. Int J Periodontics Restorative Dent, 28, 265-271
Taschieri, S., Del, F.M., Testori, T., Weinstein, R. (2007) Efficacy of xenogeneic bone grafting with guided tissue regeneration in the management of bone defects after surgical endodontics. Journal of Oral and Maxillofacial Surgery, 65(6), 1121-1127
Tsesis, I., Faivishevsky, V., Kfir, A., Rosen, E. (2009) Outcome of surgical endodontic treatment performed by a modern technique: A meta-analysis of literature. J Endod, 35,1505-1511
Tsesis, I., Rosen, E., Tamse, A., Taschieri, S., Del, F.M. (2011) Effect of guided tissue regeneration on the outcome of surgical endodontic treatment: A systematic review and meta-analysis. Journal of Endodontics, 37(8), 1039-1045
Vaishnavi, C., Narayanan, L.L., Mohan, B. (2011) Treatment of endodontically induced periapical lesions using hydroxyapatite, platelet-rich plasma, and a combination of both: An in vivo study. Journal of Conservative Dentistry, 14(2), 140-146
von Arx, T., Cochran, D.L. (2001) Rationale for the application of the GTR principle using a barrier membrane in endodontic surgery: A proposal of classification and literature review. Int J Periodontics Restorative Dent, 21, 127-139
Balkan Journal of Dental Medicine, 2019, vol. 23, br. 2, str. 102-107