Saving a hopeless tooth with a four-wall bone defect: A case report.

Abstract

Background: Recombinant human fibroblast growth factor-2 (rhFGF-2) has been shown to effectively promote the formation of new periodontal tissues, and its efficacy has been demonstrated in clinical settings. Moreover, the clinical and radiographic outcomes in the treatment of periodontal infrabony defects can be improved by using rhFGF-2 in combination with a bone substitute. Here, we present a case of four-wall bone defect in a tooth treated by combination regenerative therapy using rhFGF-2 and beta-tricalcium phosphate (β-TCP).

Methods: A 43-year-old male with a four-wall bone defect in tooth #28 was subjected to combination therapy with rhFGF-2 and β-TCP. Periodontal clinical parameters and radiographic images were evaluated at the first visit, after the initial periodontal treatment, and after 4 months and 4 years postoperation.

Results: Although gingival recession and nonvital pulp were observed postoperation, improvements in the periodontal parameters and radiographic outcomes were subsequently recorded.

Conclusion: Periodontal regenerative therapy with a combination of rhFGF-2 and β-TCP showed great potential in the treatment of four-wall bone defects of teeth.

Key points: Periodontal regenerative therapy using recombinant human fibroblast growth factor-2 (rhFGF-2) and beta-tricalcium phosphate (β-TCP) showed immense potential in the treatment of four-wall bone defect in teeth. In addition to using computed tomography for assessing bone defects and root morphologies, an evaluation of root canal morphology and pulp diagnosis is essential for understanding the internal and external aspects of the defect, which would aid in tooth preservation. Appropriate periodontal and endodontic treatments enabled tooth preservation following apical periodontitis after periodontal regenerative therapy.

Plain language summary: This case report focuses on a new approach for the treatment of a four-wall bone defect, a significant dental issue in which the bone around the tooth is damaged, thereby decreasing the stability of the tooth. We treated a 43-year-old male patient with a combination of two key components: the growth factor rhFGF-2, which helps promote the growth of new tissues, and the synthetic bone graft substitute β-TCP, which acts as a substitute for the missing bone. Over the course of 4 years, we monitored the patient's progress using dental exams and X-ray photos. Despite some minor side effects, such as gum recession and the loss of tooth vitality, the overall condition of the tooth and surrounding bone showed significant improvement. This combination therapy shows promise in repairing similar bone defects, which would help save teeth that might otherwise be lost.