Wednesday, 7 February 2018

Art of Salvaging: Bicuspidization and Bone Grafting with Platelet Rich Fibrin in Mandibular Left First Molar – A Case Report

The increased desire of patients to salvage and maintain their dentition has forced conservative and regenerative dentistry to conserve the teeth in the mouth which are planned to be removed. Thus periodontally compromised teeth with severe vertical bone loss and furcation invasion may well be retained of their roots. In this case report bicuspidization of the left first mandibular molar with bone graft and Platelet Rich Fibrin (PRF) membrane and subsequent prosthetic treatments are presented.

The treatment and management of mandibular molar teeth exhibiting furcation invasions (FI) may involve restorative dentistry, endodontics and periodontics, so that the teeth are retained in whole or in part. Such teeth can be useful as independent units of mastication or as abutments in simple fixed bridges. Thus tooth separation and resection procedures are used to preserve as much tooth structure as possible rather than sacrificing the whole tooth. The furcation defects vary from a subtle loss of attachment in the buccal furcation area, forming a shallow pocket, to advanced pathology with deep pockets > 10 mm, advanced bone loss and clinical exposure of the furcation. In the mandibular molars, grade III defects are managed by tunnelling procedures, hemisection and bicuspidisation along with open flap debridement. 

The ultimate goal of periodontal therapy is to regenerate the lost periodontal tissues caused by periodontitis. Various controlled clinical trials have demonstrated that some of the available grafting procedures may result in periodontal regeneration in intrabony defects, but complete and predictable reconstruction of periodontal tissues is still difficult to obtain. The reason is that periodontium, once damaged has a limited capacity for regeneration. The most positive outcome of periodontal regeneration procedures in intrabony defect has been achieved with a combination of bone graft and guided tissue regeneration REVIEW OF LITERATURE Bisection or bicuspidization is the separation of mesial and distal roots of mandibular molars along with their coronal portion, where both segments are then retained individually.

Endodontic therapy is performed initially, and during the open flap debridement procedure, the bicuspidization is done and the tooth is restored with a post-endodontic restoration, keeping in mind that the restoration allows for optimal plaque control in the space between the separated roots. A 31-year-old male presented with the complaint of pain of left mandibular first molar with slight mobility. On examination, the tooth was sensitive to percussion. On probing the area, there was a 9-mm-deep periodontal pocket around the mesial aspect of the furcation area. 

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