Multidisciplinary approach to apical surgery in conjunction with the loss of buccal cortical plate.

The treatment of advanced periodontal breakdown as a result of an associated endodontic lesion continues to challenge the practitioner. Two cases of teeth with endodontic pathologic conditions that required apical surgery are presented. On raising the flap, no buccal cortical plate was found, significantly lowering the prognosis of the surgery. A barrier membrane was used in addition to the apical surgery, which on postoperative follow-up appears to have resulted in the reestablishment of the buccal cortical plate.