title: Treatment of large apical lesions with mucosal fenestration: a clinical study with long-term evaluation.
abstract: BACKGROUND
  Mucosal fenestration at the root apex may compromise the treatment results of periradicular surgery from exposing the surgical wound to the oral environment. The purpose of this study was to evaluate the long-term outcomes of periapical lesions with mucosal fenestrations treated by guided tissue regeneration (GTR) combined with the management of soft tissue defects.
  
  
  METHODS
  Five patients with mucosal fenestration and large periapical lesions were treated by endodontic surgeries and periodontal regenerative procedures during 1999 to 2006. The barrier membranes and osseous grafts were placed over the periapical defects after root end resection and retrograde filling. The mucosal openings in all cases were sutured, whereas a connective tissue graft was placed before repositioning the flap in 2 cases.
  
  
  RESULTS
  The cases involving connective tissue grafting showed complete soft tissue coverage, whereas 2 of the 3 cases involving primary closure of fenestrations still had a small soft tissue opening that was further managed by placement of a connective tissue graft beneath in 1 case and direct suturing in the other case. After at least 6 years (72-160 months) of follow-up, all cases showed complete soft tissue and radiographic healing.
  
  
  CONCLUSIONS
  Connective tissue grafting in combination with GTR therapy facilitated fenestration closure and ensured long-term success in the treatment of a large periapical bony defect with mucosal fenestration.
authors.affiliation: Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Dentistry, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Lin
authors.affiliation: Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Dentistry, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Ya-Yun
authors.initials: YY
authors.lastname: Lee
authors.affiliation: School of Dentistry, National Yang-Ming University, Taipei, Taiwan; Department of Dentistry, National Yang-Ming University Hospital, I-Lan, Taiwan.
authors.forename: Yi-Ching
authors.initials: YC
authors.lastname: Ho
authors.affiliation: Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Yi-Chen
authors.initials: YC
authors.lastname: Hsieh
authors.affiliation: Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Dentistry, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yu-Lin
authors.initials: YL
authors.lastname: Lai
authors.affiliation: Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Dentistry, National Yang-Ming University, Taipei, Taiwan. Electronic address: sylee@ym.edu.tw.
authors.forename: Shyh-Yuan
authors.initials: SY
authors.lastname: Lee
mesh_terms: D000328:Adult; D005260:Female; D016557:Guided Tissue Regeneration, Periodontal; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000473:pathology; D010486:Periapical Tissue / Q000601:surgery; D019227:Tooth Apex / Q000473:pathology*; D014076:Tooth Diseases / Q000473:pathology / Q000601:surgery*; D014092:Tooth Root / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Apical lesion; connective tissue graft; guided tissue regeneration; mucosal fenestration; periradicular surgery