Labial-cervical-vertical groove: A silent killer-Treatment of an intrabony defect due to it with platelet rich fibrin
A 47-year-old male patient reported to the Department of Periodontology, with a chief complaint of pus discharge from maxillary left central incisors with dull intermittent pain. There was no relevant medical history. The patient was a non-smoker. On clinical examination, a localized gingival inflammation was present with soft edematous tissue with the accumulation of plaque and calculus with #11 and #21. Periodontal examination depicts a pocket depth of 11 mm on mesial aspect and 8 mm on midbuccal aspect of #21 [] with no mobility. Fremitus was found to be negative precluding the possibility of trauma from occlusion and tooth was found to be vital electric and thermal pulp testing. On radiographic examination, a tear-shaped radiolucency was present with localized bone loss in #21 []. On careful examination, LCVG was found on #21 which was extending into gingival sulcus.\nThe patient was subjected to complete scaling and thorough root planning. The patient was given oral hygiene instructions. The patient was reviewed after 2 weeks. Clinical symptoms subsided, but the deep pocket was still present and hence a periodontal surgery was carried out to eradicate the underlying problem. The procedure was explained to the patient and the consent was obtained for the same. Routine blood investigations were done.\nAfter assuring surgical asepsis, a pre-procedural rinse with 0.2% chlorhexidine gluconate was accomplished. After administration of local anesthetic (2% lignocaine with 1:80000 adrenalin), the papilla preservation flap (Takei et al.) was adopted since there was sufficient space between the maxillary central incisors. A full-thickness flap was reflected on both facial and palatal surfaces. The exposed root surfaces were thoroughly scaled and root planed and bone defect carefully curetted. LCVG noted on #21 [], terminated in the cervical third of root surface was sealed with glass ionomer cement (Fuji II; GC Corporation, Tokyo, Japan) [].\nThe PRF was prepared following the protocol developed by Choukroun et al. Briefly, the procedure of PRF preparation: 10 ml intravenous blood was collected by venepuncture at the antecubital fossa. This was transferred into 10 ml sterile tube without anticoagulant and immediately centrifuged at 3000 rpm for 10 min. Fibrin clot formed in between the acellular plasma on top and the red blood cells at the bottom were separated using sterile tweezers and scissors [].\nPRF was placed in the intrabony defect with #21 []. Suturing was done using 3-0 black silk. Then periodontal dressing was given.\nThe patient received post-operative instructions and was prescribed post-operative antibiotic – amoxicillin 500 mg thrice for 7 days and analgesic – aceclofenac 100 mg twice for 3 days.\nThen, 1 week postoperatively, the dressing was removed and saline irrigation was done. The patient was monitored at regular intervals and was under maintenance therapy. At the end of 3 months and 6 months, clinical examination and intraoral periapical radiographs of the treated area were taken. The clinical measurements were repeated and compared to the baseline values.\nOn examination during subsequent follow-ups, treated area showed satisfactory healing without any post-operative complications. LCVG was completely sealed off. The pocket depth was 2 mm on mesial and 1 mm on midbuccal aspect at 6 months []. Periodontal health was stable and bone regeneration was noticed in radiograph []. The patient was satisfied with the result.