2021 Volume 64 Issue 2 Pages 171-180
Purpose: Endodontic-periodontal lesions are observed relatively frequently. The clinical symptoms can be similar to those of root fracture, perforation, and cementum detachment, therefore differential diagnosis is very important. We report a case of endodontic-periodontal disease caused by abnormal root morphology which was diagnosed as a root fracture at several dental clinics and was cured by endodontic treatment and periodontal tissue regenerative therapy.
Case: A 41-year-old female. Chief complaint: Draining of the maxillary right central incisor and occlusal pain. Systemic history: No special notes. Current medical history: She had received initial endodontic treatment for a trauma-induced fracture of her anterior teeth about 30 years ago. After that, she had undergone re-treatment by her primary care physician twice due to caries and other reasons. When she visited another doctor in January 2018 for spontaneous pain, she was diagnosed with a root fracture of the upper right central incisor, and tooth extraction was recommended. She had a strong desire to preserve her tooth and consulted four dentists, but all of them diagnosed similar results. Therefore, she visited the Osaka University Dental Hospital in February 2018 for a detailed examination and treatment of the same site. Clinical findings: The maxillary right central incisor had a resin faced crown with spontaneous pain (+), percussion pain (+), gingival swelling (+), mobility (degree 2), root tenderness (+), sinus tract (−), and probing depth (PD, 11 mm) at the center of the palatal side. Cone beam computed tomography (CBCT) showed a large apex transmission image that expanded to the incisal canal. Diagnosis: Maxillary right central incisor, previously treated, acute periapical periodontitis, endodontic-periodontal lesion type III.
Treatment process: On the first visit, after CBCT imaging, occlusal adjustment and removal of supragingival tartar, it was decided to sedate the acute inflammation with antibiotics. After the acute symptoms improved, the resin faced crown was removed and the infected root canal treatment was started. After treatment, the radiolucency of the apical region in the right upper incisor was reduced, so we performed root canal filling. Approximately 4 months after the infected root canal treatment, periodontal tissue regenerative therapy using REGROTH (Kaken Pharmaceutical) was performed as the PD was not fully improved even after the completion of the initial preparation. During the surgery, an abnormal root morphology was found in the center of the palate rather than a root fracture, and tartar-like calcite was deposited in the root sulcus. One year and four months after the surgery, periodontal tissue regeneration at the site was radiographically confirmed, and the clinical symptoms disappeared.
Conclusion: The clinical examination showed that the apical translucency had extended to the incisal canal, and extraction of the tooth was thought to be appropriate at the first visit. However, the clinical symptoms were dramatically improved by ensuring the removal of the source of infection by CBCT and dental operative macroscope during endodontic treatment and periodontal tissue regenerative therapy for endodontic-periodontal disease due to abnormal root morphology not root fracture.
