Management of millers class III marginal tissue recession associated with endodontic lesion: Report of two cases managed using secondstage surgery

ABSTRACT Introduction: Endo perio lesions are common conditions that are often difficult to diagnose and are persistent if not treated completely. However, if the patient’s history is taken carefully and thorough evaluation of all possible routes of infection is carried out, a properly done endodontic treatment is sufficient to eliminate the infection. However, wherever a secondary periodontal involvement exists, it requires specific therapy to achieve success. Case Series: In the first case, the involved maxillary left first premolar had a severe marginal tissue recession completely exposing the buccal root. The case was further complicated by the presence of an endodontic lesion. After successfully completing endodontic therapy, a free gingival autograft was placed to increase the zone of attached gingiva. Subsequently, a connective tissue graft was placed using pouch and tunnel technique to augment the zone further. The second case had a Millers class III recession associated with an endo perio lesion. This case was managed by using a resorbable membrane with a bone graft substitute to correct the osseous defect in the first stage after a successful endodontic therapy. The second­stage surgery was done using an envelope technique for connective tissue grafting. In both the cases, there was an increase in width and thickness of the zone of attached gingiva following the two­step surgical procedure after a successful endodontic therapy. Conclusion: Successful treatment reported in both the cases can be attributed to a correct diagnosis, successful endodontic therapy and an increased zone of attached gingiva achieved using a two­step surgical technique.