2021 Volume 64 Issue 4 Pages 279-284
Purpose: Endodontic-periodontal lesions are usually given root canal treatments rather than periodontal treatments, because root canal treatments are thought to be more effective. However, when apical periodontitis is accompanied by chronic pericoronitis and bone loss around the wisdom tooth behind it, the first choice of treatment procedure is less clear. But even in this case, we obtained highly successful results from treatment based on performing the root canal treatment first, and then dealing with the apical periodontitis below and behind it by extracting the wisdom tooth.
Case: The patient was a 36-year-old woman who was six months pregnant. She came to the hospital in order to receive treatment for gingival swelling of the left mandibular molar. She had a history of partial restoration by means of a metal inlay about 10 years ago, and had had no discomfort since that treatment. But since about six months ago, she had begun to feel some gingival swelling on the #37 distal side. Based on periodontal examinations and local deep probing around #37, she was found to have tooth mobility of Grade 2. In addition, the crown of the mandibular left third molar (#38) was partially exposed in the oral cavity, and gingival swelling and redness appeared in the mucosa around the area of #38. Dental X-ray showed periapical radiolucency at the apex of #37 to be approximately of crown size, and a half-moon shape radiolucency that extended along the horizontally impacted tooth #38 to just below the mesial contact area. Based on the intra-oral examinations and diagnostic tests, #37 was suspected to have been non-vital. Therefore, we judged from pre-treatment diagnosis that there was chronic apical periodontitis of #37 and chronic pericoronitis of #38. Root canal treatment of tooth #37 was performed first, then root canal filling by lateral condensation and core build-up was performed, thereby removing the former discomfort and clinical condition. Subsequently, tooth #38 was extracted, and #37 was immediately restored with a temporary crown, observed, and finally restored with a full coverage crown prosthodontic. Clinical examination at around one year after all the treatments revealed that the condition was quite normal.
Conclusion: In a case of apical periodontitis with the complication of chronic pericoronitis, we consider that root canal treatment first is most effective, and can lead to healing regardless of periapical lesion size.
