Management of tooth with endodontic-periodontal lesion with communication: case report

To report a clinical case a patient with endodontic-periodontal lesion with communication, treatment and observed results. 39 years old women was referred to Periodontology Department in Insitute of Stomatology with complaints about the pain on cold and hot stimuli on d36. A patient was diagnosed with generalized periodontitis grade IV, stage C. Baseline clinical examination - deep pockets DB and DL - 10mm, bleeding on probing, furcation involvement, tooth mobility I grade. Tooth was partly vital. Radiographic examination revealed periapical and lateral translucency. The prognosis for this tooth was set as questionable. D36 initially underwent endodontic treatment. Ledermix paste (LP) was left in root canals and glass ionomer cement secured the cavity. After four weeks intracanal medicament was changed to a 50:50 mixture of LP and Ca(OH)2 paste.Then the periodontal non-surgical treatment was done. Evaluating the results after 2 months, pocket depth was reduced to 7mm with bleeding on probing. That was not accepted as healed periodontium and surgical treatment was done. Two months after periodontal surgery, pocket depth was reduced to 4mm without bleeding on probing. It was accepted as a stabile periodontal situation and the endodontic canal treatment was finished with obturation. Final restoration with the composite filling was done. At the 6-months evaluation treatment with a combination of endodontic and periodontal therapies, the healing was observed clinically – pocket depth was reduced to 4mm, without bleeding on probing, no furcation involvement and mobility was detected anymore. Signs of a reduction in inflammation were also observed radiographically. This case report demonstrates the sequential treatment of endodontic periodontal lesions with communication with observable healing. Treatment of such defects takes a long time, therefore, it is essential to continually reassess the prognosis after each phase of treatment and after appropriate time intervals to allow healing and stabilization of the tissues.