Contiguous autogenous transplant nineteen years' clinical and radiographic follow-up: A case report
The aim of this report is to show a 19-year follow-up of clinical and radiographic response of cases treated using a bone-swaying procedure (contiguous autogenous bone graft). A 46-year-old woman complained of severe pain at the mandibular left canine (canine was an abutment to a fixed partial denture).Vitality indicated that 22 was vital with PD 5 mm (B), 10 mm (DB and DL), and 7 mm (D). PA x-ray showed severe bone loss on the distal with a intrabony defect. The patient received SRP and OHI. One month later the area was treated with an open-flap curettage (visual inspection revealed a combined one- and two-walled intrabony defect). Two months later there were radiographic signs of improvement, PD 7 mm (D). A contiguous autogenous bone graft procedure was performed. A postoperative radiograph showed that the transplant was in close contact with the root and partially disconnected from its base. The sutures were removed after 10 days, and OH was reinforced. Three months after the procedure, the graft appeared radiographically to be fully integrated (with regeneration of bone). PD at the distal of 22 was 2 mm, and gingival recession was minimal. At this stage, a new fixed partial denture was constructed. Clinical examination after one year showed a healthy gingiva and PD. PA X rays showed a normal trabeculation and a PDL space narrower than the one seen six months before. The patient was seen for maintenance therapy twice a year. Between the sixth and seventh year, PD on the (D) increased from 3 to 5 mm. An X ray was taken with a gutta-percha point. The area previously referred to as widened PDL space could be considered a shallow, narrow intrabony defect. The patient continued on a maintenance program. A PD of 6 mm was recorded 17 years postsurgery. An X ray showed an angular bony defect with attachment loss. No significant changes were reported at 18- and 19-year examinations.
The present long-term follow-up provided information that encouraged speculation about the surgical procedure and the type of healing achieved. Clinically, probing attachment remained almost unchanged during the first seven years (radiographically there was a gain in bone height).The radiographic łgap˛ seen as early as six months postsurgically was the only sign that suggested the possibility that a long junctional epithelium or connective tissue was interposed between the bone and the root surface. Early diagnosis and correct interpretation of radiographs may alert clinicians to the possibility of future breakdown. [c.c.]
Sperling I., A. Kozlovsky, and H.Tal, Quint Int, 24:555, 1994