J Periodontal Implant Sci.  2013 Jun;43(3):136-140. 10.5051/jpis.2013.43.3.136.

Endodontic treatment enhances the regenerative potential of teeth with advanced periodontal disease with secondary endodontic involvement

• Kwon EY
• Cho Y
• Lee JY
• Kim SJ
• Choi J

• KMID: 1798487
• DOI: http://doi.org/10.5051/jpis.2013.43.3.136

Abstract

PURPOSE
The aim of this study was to identify a role for endodontic intervention in enhancing the regenerative potential of the periodontal ligament when combined with periodontal treatment in seriously involved teeth with a secondary endodontic component.
METHODS
Patients who exhibited radiolucency extending to the periapical region, abnormal electric pulp testing values, and deep probing depth derived from primary periodontal disease with secondary endodontic involvement were included. Intentional root canal treatment was applied to those teeth in which the apical lesions were presumed to communicate with those of the periodontal lesion of the teeth that remained vital. In all three selected cases, regenerative periodontal therapy incorporating either bone graft or guided tissue regeneration was instituted 3 months after the endodontic intervention.
RESULTS
Remarkable enhancement in radiographic density was noticeable around the affected teeth as evidenced by changes in radiopacity. There was a significant reduction in the probing pocket depth and gain in the clinical attachment level. Chewing discomfort gradually disappeared from the commencement of the combined treatment.
CONCLUSIONS
An intentional endodontic intervention may be a worthwhile approach for the sophisticated management of teeth suffering from serious attachment loss and alveolar bone destruction with concomitant secondary endodontic involvement.

Keyword

Periodontal attachment loss; Periodontal disease; Root canal therapy

MeSH Terms

Dental Pulp Cavity
Guided Tissue Regeneration
Humans
Periodontal Attachment Loss
Periodontal Diseases
Periodontal Ligament
Root Canal Therapy
Stress, Psychological
Tooth

Figure

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  Figure 1 Initial intraoral clinical view (A) of upper right first premolar and at the time of periodontal surgery showing palatal bone defect and calculus deposit (B). Debridement and bone graft (xenograft) were performed (C). Clinical view at the time of 1-year recall check-up after endodontic and periodontal treatment (D).

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  Figure 2 Periapical radiograph of upper right first premolar at initial visit (A) and at the time of 3-month recall check-up after endodontic treatment (B). There was no change in the radiographic bone defect morphology. Periapical radiograph at the time of 1-year recall check-up after endodontic and periodontal treatment (C). Note the changes of the radiolucency.

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  Figure 3 Initial intraoral clinical view of lower left first molar (A). Clinical view at the time of periodontal surgery showing distal circumferential bone defect (B). Debridement and bone graft (xenograft) were performed (C). Clinical view at the time of 9-month recall check-up after endodontic and periodontal treatment (D).

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  Figure 4 Periapical radiograph at the time of 3-month recall check-up after endodontic treatment (A). There was no change of bone defect in periapical radiograph compared to initial periapical radiograph (Unfortunately, initial radiograph is not shown here.). Periapical radiograph at the time of 9-month recall check-up after endodontic and periodontal treatment (B).

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  Figure 5 Initial intraoral clinical view of lower left second molar (A) and at the time of periodontal surgery showing distal circumferential bone defect (B). Debridement and bone graft (xenograft) and nonresorbable membrane (expanded polytetrafluoroethylene) adaptation were performed (C). Clinical view at the time of 1-year recall check-up after endodontic and periodontal treatment (D).

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  Figure 6 Initial periapical radiograph of lower left second molar showing circumferential bone defect around distal root (A). Periapical radiograph at the time of 3-month recall check-up after endodontic treatment (B). There was no change in the radiographic bone defect morphology. Periapical radiograph at the time of 1-year recall check-up after endodontic and periodontal treatment (C).

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