Management of Root Fenestration Using Buccal Decortication and Guided Tissue Regeneration: A Case Report and 3-dimensional Analysis

The management of patients with apical fenestration and clinical symptoms has always been limited to apical root resection and placement of the root tip within the bony crypt. This result would often present resolution of clinical symptoms based on a few case studies. In this case report, we present a case in which apical resection alone did not resolve the patient's discomfort; on the contrary, it resulted in further bone loss and persistence of clinical symptoms. A corrective surgery was performed with the use of guided bone regeneration in conjunction with decortication of the cortical plate to induce bleeding. The patient symptoms resolved within a few weeks after the surgery, and the follow-up scan showed apical root coverage. Three-dimensional analysis was performed to compare the bony changes between the 2 surgeries and showed a significant amount of bone gain of around 200 mm³ and a 2-mm linear bone gain opposite the distobuccal root. The case presents a conservative approach to manage root fenestration of the buccal plate without further compromising the root apex.