Managing Combined Periodontal-Endodontic Lesions Of Endodontic Origin: Case Report

Identifying the source of combined periodontal-endodontic lesions is crucial for treatment planning. A 53-year-old female presented with occlusal discomfort and food impaction in the upper left posterior tooth for one year. Tooth 27 had deep caries, Grade II mobility, percussion sensitivity, a distobuccal gingival abscess, and a 10mm periodontal pocket at the distobuccal site. The PD elsewhere of this tooth were 3-7 mm. Radiographs and CBCT revealed a cervical radiolucency close to the pulp chamber and a 15×12×9 mm3 periapical radiolucency with distal alveolar bone loss to the apex. A combined periodontal-endodontic lesion of pulpal origin was diagnosed, and root canal therapy and periodontal initial therapy were initiated. After the treatment, the abscess resolved, and the symptom of occlusal discomfort was relieved. The patient was recalled 3 and 6 months after. Tooth 27 exhibited no mobility, reduced periodontal pocket depth, and diminished periapical lesions. An onlay crown was then placed. At 2- and 3-year follow-ups, the tooth was asymptomatic, non-mobile, no periapical pathology, with a well-fitting crown. This case presented with a clear endodontic infection origin. The periodontal destruction was localized to the affected tooth, while the remaining teeth maintained favorable periodontal conditions, indicating that satisfactory therapeutic outcomes could usually be achieved through root canal therapy alone. However, the severe periodontal destruction in this case necessitated adjunctive periodontal therapy for optimal outcomes. The 3-year clinical follow-up demonstrated a favorable prognosis of the affected tooth.