Successful management of primary periodontal lesion with secondary endodontic involvement: A case report (KEY IJP************594)

• Soukaina El Kharroubi,Malika Karami

Abstract

ABSTRACT:Simring & Goldberg initially documented the connection between periodontal and pulpal diseases in 1964 1. The periodontium connects with the dental pulp via several pathways, such as dentinal tubules, the apical foramen, as well as lateral and accessory canals. These pathways facilitate the transmission of pathological agents between the pulp and periodontium, leading to the formation of endo-perio lesions 2. A 39-year-old female patient presented with dental mobility and a fistula adjacent to the left mandibular molar. The patient had no previous dental treatment and was in good systemic health. Clinical intraoral examination of tooth 37 revealed a non-carious tooth with fissure infiltration and supragingival plaque. The tooth did not respond to sensitivity tests and was positive for percussion testing. Periodontal examination showed deep periodontal pockets on the vestibular and palatal surfaces (more than 5 mm) with mobility degree 2. Radiographic examination revealed widening of the periodontal ligament space, a clearly visible periapical lesion, furcation involvement, and horizontal bone loss. Endodontic treatment was performed over two visits under rubber dam isolation, spanning two weeks, with inter-visit calcium hydroxide as an intra-canal medication. The canal was obturated, and access restoration was completed with glass ionomer cement and resin composite at the third visit. Concurrent periodontal debridement was also performed. The article aims to illustrate the effective handling of a primary periodontal lesion accompanied by secondary endodontic involvement, as demonstrated by our successful case report of a second mandibular molar treated with Phase I endodontic and periodontal therapy. Despite the initially guarded prognosis, treatment resulted in resolution of the fistula and reduced tooth mobility.