Cervera Ballester J, Peñarrocha Oltra D, Peñarrocha Diago MA, Maestre Ferrín L, Peñarrocha M. Bone block graft to treat an apicomarginal defect simultaneously with apical surgery of the maxillary incisors: a case report with three-year follow-up. J Oral Science Rehabilitation. 2016;2 (2):36–40
An apicomarginal defect is defined as a localized bony defect that is characterized by the absence of alveolar bone over the entire root length. This type of defect significantly reduces the prognosis of periapical surgery.
Hirsch et al. and Skoglund and Persson observed healing rates of 27% and 37%, respectively, in teeth that had undergone periapical surgery and with apicomarginal defects, substantially lower than teeth in which the vestibular cortical was intact. Current surgical techniques, supported by the use of ultrasound, amplification and magnification devices, have improved the prognosis of periapical surgery, also in teeth with this type of bony defect. Kim et al. observed a healing success of 77.5% in teeth with apicomarginal defects using a microsurgical technique, but still significantly lower than the 95.2% rate of teeth with lesions confined to the apical area.
The reason for the poorer prognosis in teeth with apicomarginal defects has been suggested to be the formation of a long junctional epithelium over the denuded root surface, preventing bone regeneration. Experimental and clinical studies have shown significantly higher success rates with the use of tissue regeneration techniques (guided tissue regeneration, GTR) in apicomarginal defects.
The purpose of this article is to describe the successful management of an apicomarginal defect of a maxillary lateral incisor with a bone block graft performed simultaneously with apical surgery of both lateral and central incisors.