Management of orthodontically induced mucogingival fenestration: A rare case report

Gingival fenestrations are of uncertain etiotogy having rarely been reported in the dental literature. It seems to have multifactorial origin and is commonly associated with the anterior region of the arch especially the incisors. The etiology of such defects can be due to decreased thickness of the alveolar housing, contour of the root apex, orthodontic tooth movement and endodontic pathology. To established an accurate diagnosis and proper institution of multidisciplinary comprehensive treatment protocol for salvaging teeth with complex orthodontic –periodontal problem. A 24- year old female patient reported to the department of Periodontics with exposed root in relation to maxillary right central incisor. History revealed previous orthodontic treatment 2-3 years back. On intra oral examination tooth exhibited grade 1 mobility and midline diastema. Apical portion of the root was seen perforating the buccal cortical plate and the mucosa. An interdisciplinary treatment was instituted which included root canal treatment followed by root end resection and soft tissue management. This case report resulted in an uneventful healing with coverage of the complete root apex and diastema closure with complete patient satisfaction. Combined orthodontic-periodontal problems offer great challenges to a clinician, therefore, an accurate diagnosis and treatment planning should be made accordingly for optimum outcome.