Estudiante medico estomatologo

Case Report

Combined endodontic - Periodontal lesion: A
clinical dilemma
Pushpendra Kumar Verma, Ruchi Srivastava1, K. K. Gupta1, Amitabh Srivastava1
Departments of Conservative Dentistry and Endodontics, 1Periodontology and Implantology, Sardar Patel
Postgraduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India

Address for correspondence: Dr. Pushpendra KumarVerma, E-mail: pushpendrakgmc@gmail.com

ABSTRACT
Endodontic-periodontal combined lesion is a clinical dilemma because making a differential diagnosis and deciding a prognosis
are difficult. Lesions of the periodontal ligament and adjacent alveolar bone may originate from infections of the periodontium
or tissues of the dental pulp. Periradicular bone loss secondary to endodontic pathosis istypically seen in teeth with necrotic
pulps. The ultimate goal of periodontal therapy is not only to maintain the natural dentition, but also to restore lost periodontium.
Combined periodontal and endodontic diseases involve the periodontal attachment apparatus. The treatment of endodonticperiodontal combined lesions requires both endodontic therapy and periodontal regenerative procedures. Withadvancements
in new techniques and materials different treatment choices are available, providing a superior prognosis. This article includes
case reports of combined endo-perio lesions which were first treated with conventional endodontic therapy and then followed
by periodontal surgery. This combined treatment resulted in a radiographical evidence of alveolar bone gain. This case reportdemonstrates that proper diagnosis, followed by removal of etiological factors and utilizing the combined treatment modalities
will restore health and function to the teeth with severe attachment loss caused by an endo-perio lesion.
Key words: Combined endodontic-periodontal lesion, guided tissue regeneration, periradicular surgery

INTRODUCTION

P

reservation of the natural dentition is theultimate goal of dental therapy. In periodontics,
the goal is not only to maintain the natural dentition,
but also to restore lost periodontium. Lesions of the
periodontal ligament and adjacent alveolar bone
may originate from infections of the periodontium
or tissues of dental pulp.[1] Periradicular bone loss
secondary to endodontic pathosis is typically seen
in teeth with necrotic pulps.Combined periodontal
and endodontic diseases involve the periodontal
attachment apparatus. Pulpal necrosis may lead to
destruction of the attachment apparatus by extension
through the apical foramen or through accessory
canals that may be located at different levels on the
r oot surface. An acceptable treatment results, for
combined endodontal and periodontal (endo-perio)
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lesions may be obtained by endo-perio therapy.
However, when a significant loss of the periodontal
attachment apparatus and osseous structure occurs,
the long-term prognosis becomes poor.[2]
Formulating a differential diagnosis among combined
lesions has been challenging. Therefore, diagnostic
steps should include thorough patient-reported
dental history, visual inspection forpresence of sinus
tract and severe inflammation in association with large
r estoration and anatomic anomalies such as palatal
grooves,[3] radiographical confirmation with tracing
the sinus track, results of clinical findings including
p ercussion and palpation, routine periodontal
assessment for presence of mobility or deep probing
depth, testing for coronal cracks and pulp vitalitytesting.[4] These tests are customarily accepted as
being reliable in differentiating between pulpal and
periodontal disease.

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DOI:
10.4103/2229-5194.85034

Journal of Interdisciplinary Dentistry / Jul-Dec 2011 / Vol-1 / Issue-2

This report presents a few cases in which no bone
r emained around the facial and apical areas of
maxillary...