2022 Volume 65 Issue 5 Pages 294-304
The treatment of endo-periodontal lesions requires careful consideration because of their complicated clinical condition due to the pathological connection between dental pulp and root canals, and periodontal tissues. By presenting three cases of endo-periodontal lesions with different etiologies, this paper describes appropriate treatments and precautions for each case.
Case 1: Type Ⅰ endo-periodontal lesion, 45; The patient was a 74-year-old woman. The probing pocket depth (PPD) on the buccal areas of 45 was 8 mm in the midbuccal and mesiobuccal areas and 6 mm in the distobuccal area. Probing of the three areas resulted in bleeding. 45 had grade Ⅱ mobility and did not respond to thermal and electric pulp vital tests. Radiography of 45 showed a large restoration located close to the pulp. The lamina dura had disappeared, and the radiolucency of the area surrounding the tooth root from the root apex to the alveolar crest was increased.
Case 2: Type Ⅱ endo-periodontal lesion, 44; The patient was a 41-year-old woman. 44 had gingival recession and exposed tooth root with the root groove. The deepest PPD on 44 was 4 mm in the mesiobuccal and distobuccal areas. Probing of the two areas resulted in bleeding. 44 did not respond to thermal and electric pulp vital tests. The level of the alveolar bone crest was one-third, and vertical bone resorption from that site was observed and it reached the root apex. A semicircular radiolucent image was also observed around the apex. Periodontal tissue examination and radiographical examinations showed that she suffered from generalized aggressive periodontitis.
Case 3: Type Ⅲ endo-periodontal lesions, 47; The patient was a 53-year-old man. The deepest PPD on 47 was 13 mm in the midbuccal area with pus discharge. Probing of the area resulted in bleeding. 47 had grade Ⅱ mobility. X-ray/cone-beam CT (CBCT) images showed a C-shaped root and extensive radiolucency of periodontal tissue from the alveolar bone crest to the apex. Periodontal tissue examination and radiographical examinations showed that he suffered from localized chronic periodontitis.
Conclusion: Distinguishing the type of endo-periodontal lesions should be comprehensively done based on radiographic findings, PPD, pulp vital response on an affected tooth, and the condition of the periodontal tissue around the tooth and in the upper and lower jaws.
