Successful management of a tooth with endodontic-periodontal lesion: A case report

A Multi-Disciplinary Approach in the Management of Endo-Perio Lesions: A 4-year Follow-Up Case Report

Summary. This case report discusses the multi-disciplinary approach and long-term follow-up of a 66-year-old male who suffered a combined endodontic-periodontal lesion (EPL). As EPL is uncommon in daily practice and dentists' knowledge and awareness of EPL is quite low, this case becomes of high interest and value to document and research. The objective of this study is to present the diagnosis, multi-disciplinary approach, and long-term follow-up of compromised teeth with EPL. It highlights the importance of the identification and elimination of all causative factors as well as the correct treatment sequence to achieve a predictable outcome. The patient was referred to the periodontist after multiple unsuccessful attempts by his previous dentist. He complained of recurrent dull pain and abscess on his upper left tooth (tooth #26) that had been present for the past three years. A diagnosis of combined EPL was obtained after thorough anamnesis, clinical evaluation, and radiographic examination. The clinician identified several predisposing factors, such as plaque, trauma from occlusion, and excessive force on tooth #26 due to incorrect denture design. Treatment involved multiple dental specialties. At the periodontist, the patient underwent scaling, root planning, and removal of overhanging part of the restoration. At the endodontist, root canal treatment (RCT) was completed. Two months after RCT, a periodontal regenerative procedure was done. The defect was filled with a combination of allograft/alloplastic bone graft and covered with a barrier membrane. Upon healing, the prosthodontist did the final restoration of fiber post with a metal crown on tooth #26 and constructed a new denture with a periodontal-friendly design. A follow-up at five months and four years showed excellent results. The patient was symptom-free, and tooth #26 showed no periodontal inflammation. Radiographic examination showed a good bone fill at the defect. Supportive periodontal therapy should be emphasized to achieve the long-term success of EPL.

Bioceramic Cements: Supporting in Remineralization of Osteolytic Lesions in Endodontic-periodontal Diseases: A Report of Two Cases

Bioceramic cements used for filling root canals in cases of endo-perio lesion of endodontic origin seem to be promising due to having the potential of promoting faster and more predictable healing of the periapical lesion as they stimulate osteogenesis. An effective treatment plan depends on the precise diagnosis of endo-perio lesions. The origin of an infection, being exclusive to the root canal, from the periodontium, or both, is extremely important for devising the treatment plan. In both cases, no clinical evidence of periodontal disease (bleeding, calculus, etc.) was found; however, primary endodontic lesions with the possibility of drainage through the gingival crevice were present. In addition to the disinfection strategies used during the root canal treatments, the bioceramics Bio C Sealer, Bio C Repair and Bio Root RCS were used to fill in the root canals. Both cases presented an impressive bone gain within 8 months for case 1 and 5 months for case 2. Regarding case 1, in the palatal root canal an apical plug with a bioceramic repair cement was used. Based on the literature studied, it can be concluded that after adequate disinfection of the root canals, using bioceramic cements in filling the root canals shows the potential of supporting capabilities in remineralization of osteolytic lesions in endo-perio diseases.