Management Of Combined Periodontal- Endodontic Lesions With Post-Core Restoration

The successful management of combined periodontal-endodontic lesions required accurate diagnosis and adequate treatment. This case achieved successful outcomes through accurate identification of root canal-originated infection, complete removal of the post-core crown, and establishment of retreatment pathways for effective infection control. A 29-year-old female presented with a 1-year history of gingival swelling in the right mandibular second molar, which had received root canal treatment (RCT) and post-core crown restoration for 5 years. Clinical examination revealed an 8mm periodontal pocket in the lingual gingiva, while in other sites the probing depths was 2–3mm. Radiographic and CBCT imaging demonstrated inadequate root filling, a large periapical radiolucency extending to the furcation, and S-shaped root canal. Under rubber dam isolation and microscope magnification, the fiber post was removed using an ET25 instrument. Retreatment involved nickel-titanium files, S-shaped curvature with small-sized C-files and 1% NaOCl irrigation for canal shaping and cleaning, as well as calcium hydroxide for interappointment medication. Obturation with iRoot SP and warm gutta-percha was completed in the last visits. At 6-month follow-up, the periapical lesion had significantly reduced, and complete resolution was observed at 2 year post-treatment. The periodontal involvement was due to incomplete initial RCT. Key challenges included accurate diagnosis, fiber post removal and glide path establishment in S-shaped canal. Effective disinfection contributed to the successful outcome. For combined periodontal-endodontic lesions of pulpal origin, retreatment with advanced infection control ensures favorable prognosis.