PMC3915392_01
Preoperative clinical
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F1
Department of Endodontics. During the clinical examination, the left maxillary lateral incisor (#10) had an intact crown without caries or fracture, with negative vitality testing and a positive response to percussion [Figure 1].
Preoperative clinical palatal view
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Periodontal probing disclosed a periodontal pocket (9 mm) at the mesiopalatal line angle of the tooth and concomitantly, a PGG which extended into the gingival sulcus [Figure 2].
Preoperative occlusal view
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F3
An occlusal radiograph revealed a large periapical lesion with a bony defect extending beyond the apical third of the root [Figure 3].
Palatogingival groove exposed after elevating a full thickness flap
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F4
A surgical flap was raised from the palatal aspect and labial aspect, and the PGG was isolated to its most apical extent [Figure 4].
Sealing of the PGG with biodentin
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Maur-des-Fosses, France) was applied into the defect [Figure 5].
Removal of the granulation tissue and debriding the defect
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Maur-des-Fosses, France) [Figure 6].
Placement of bone graft
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The bony defect was filled with freeze-dried bone allograft (LifeNet, Virginia Beach, VA) [Figure 7].
Placement of platelet-rich fibrin membrane
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F8
Without delay autologous PRF membrane was placed [Figure 8] and the flaps were secured with 4-0 polyglactin 910 sutures (Vicryl, Ethicon, Inc., Piscataway, NJ).
Twenty-four month follow-up
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There was a significant reduction in radiolucency radiographically [Figure 9].