Use of Platelet-Rich Plasma Combined With Hydroxyapatite in the Management of a Periodontal Endosseous Defect Associated With a Palato-Radicular Groove

Use of Platelet-Rich Plasma Use of Platelet-Rich Plasma Combined With Hydroxyapatite in Combined With Hydroxyapatite in the Management of a Periodontal the Management of a Periodontal

Endosseous Defect Associated With Endosseous Defect Associated With a Palato-Radicular Groove: a Palato-Radicular Groove:

A Case RepoA Case Reportrt

REPORTER: Janine RumbaoaREPORTER: Janine Rumbaoa

Various root developmental anomalies, such as palato-radicular groove, have been associated with worsening the periodontal condition.

PALATO-RADICULAR GROOVE•Palato-radicular groove (PRG) is one of the rare developmental anomalies of maxillary incisor teeth, primarily maxillary lateral incisor.•It usually begins in the central fossa, crosses the cingulum and extends to varying distance apically, possibly reaching the root apex

There lack of epithelial closure which makes it an important niche for microbes.

TERMINOLOGY

PLATERICH PLASMA is blood plasma that has been enriched with platelets. As a concentrated source of autologous platelets, PRP contains (and releases through degranulation) several different growth factors and other cytokines that stimulate healing of bone and soft tissue.

HYDROXYAPATITE

CASE PRESENTATION

• A 36-year-old Indian female

• Pain in the upper maxillary incisor region

Probing depth (PD) on the mesiopalataland mesiolabial aspect of tooth #10 was 7 mm

clinical attachmentlevel (CAL)was 9mmmesiolabially and mesiopalatally

gingival recessionwas 2mm interproximally, and no mobility was detected

On thepalatal aspect of tooth #10, there was a deep palatoradiculargroove initiating from the cingulum of the tooth and extending apically

CASE MANAGEMENT

Phase I periodontal therapy, endodontic therapy of tooth#10, and surgical periodontal therapy was done

Endodontictherapy of tooth #10 resulted in the reduction of the periapicallesion

For esthetic purposes, a modified papillapreservation technique was used.

a full-thickness flap was raised, and thorough debridementand root planing was performed. The palato-radiculargroove was restored with GIC

PRP Gel Preparation

blood were drawn from the antecubitalvein and collected in sterile plastic test tubes

Test tubes were shaken gently and retained at roomtemperature for a minimum of 45 minutes to minimize thecomplement activity.

Subsequently, the citrated blood solutionwas centrifuged, using a refrigerated resulting in separation of threefractions: erythrocytes at the bottom layer, PRP in the middlelayer, and platelet-poor plasma (PPP) at the top layer

Flapswere approximated with interrupted sutures of 3-0 blackSilk and periodontal dressing{ was placed.

Sutures were removed after 1 week. The 6-month postoperative pictureshows uneventful healing.

Full ceramic crown on tooth #10 and construction of thedistal surface of tooth #9 with a light-cured composite resinrestoration was done

CLINICAL OUTCOMESReexamination after 12 months revealed reduction in PD(from 7 to 2 mm) and CAL (from 9 to 4 mm)

significant radiographic bone formation in theperiodontal endosseous defect

DISCUSSION

PRP stimulates the proliferation of periodontal ligament and osteoblastic cells, while at the same time, epithelial cell proliferation is inhibited.

Because of its fibrinogen content,PRP reactswiththrombin andinduces fibrin clot formation, which in turn is capableof upregulating collagen synthesis in the extracellular matrix and provides a favorable scaffoldfor cellularmigration and adhesion

• The fibrin component of PRP gel not only works as a hemostatic agent aiding in the stabilization of the graft material and the blood clot,13 but also adheres to the root surface and may impede the apical migration of epithelial cells and connective tissue cells from the flap