Late‐onset external root resorption following periodontal regenerative therapy using rhFGF‐2 and DBBM: A case report
Yoshimi Saito, Kentaro Imamura, Mayuri Ambiru, Hideto Aoki, Masahiko Nikaido, Atsushi SaitoAbstract
Background
Periodontal regenerative therapy using recombinant human fibroblast growth factor‐2 (rhFGF‐2) combined with deproteinized bovine bone mineral (DBBM) has demonstrated favorable and predictable clinical outcomes for intrabony defects. However, long‐term outcomes and potential challenges following such combination therapies remain poorly documented.
Methods
A 40‐year‐old woman with generalized stage III grade C periodontitis underwent periodontal regenerative therapy using rhFGF‐2 combined with DBBM for a one‐wall defect at the mandibular left first molar (#19).
Results
Favorable periodontal healing was maintained for approximately 4 years. However, for tooth #19, the probing depth gradually increased at 5 years 2 months post‐surgery, and the patient developed discomfort and pulpal symptoms by 6 years 2 months. Clinical examination revealed an agglomerate of DBBM particles and a palpable external root resorption lesion. The tooth was extracted due to irreversible pulpal involvement.
Conclusion
This case illustrates that despite favorable early healing, periodontal regenerative therapy may lead to rare late‐onset complications such as external root resorption. Long‐term follow‐up and careful consideration of biomaterial interactions are essential when employing combination regenerative approaches.
Key points
Periodontal regenerative therapy using rhFGF‐2 and DBBM achieved favorable clinical outcomes for 4 years before unexpected late‐onset external root resorption developed. Long‐term persistence and partial separation of DBBM particles, along with the response of macrophage‐ or osteoclast‐lineage cells, are associated with a potential for delayed resorptive pathology on adjacent root surfaces. Clinicians should recognize the possibility of late complications and carefully consider biomaterial interactions when selecting regenerative strategies and informing patients.