Multidisciplinary Management of Apical Dehiscence and Mucosal Fenestration on a Mandibular Incisor Using Cone-Beam Computed Tomography-Guided Periodontal Regenerative Therapy: A Case Report

Abstract

Apical dehiscence is a bony defect on the buccal root surface that exposes the root without involving the marginal alveolar bone, often resulting from adverse tooth position, trauma, or orthodontic movement. This report details the multidisciplinary management of a combined endo-perio lesion presenting as a persistent mucosal fenestration at the apex of an endodontically treated mandibular incisor, tooth #24, in a 51-year-old female patient. A two-dimensional (2D) radiograph failed to reveal the extent of the defect, but a Cone-Beam Computed Tomography scan provided a definitive three-dimensional (3D) diagnosis: the root apex was positioned outside the labial cortical plate, exhibiting severe apical dehiscence. Given the thin bone and severe depression defect, the option of extraction and implant placement was ruled out. The case was successfully resolved through endodontic microsurgery, root end refinement, combined with Periodontal Regenerative Therapy, utilizing a bone graft for hard tissue augmentation and a Subepithelial Connective Tissue Graft for stable soft tissue repair. This report illustrates the critical role of advanced imaging for accurate diagnosis and treatment planning in managing complex apical fenestrations and affirms the long-term value of tooth preservation.