Endo-perio relationship

Today I reviewed a case I assumed had a periodontal relationship and would not resolve with endodontics alone.  Well a nice surprise awaited when the patient reported that he had no symptoms and was comfortable 

molar endo and perio relationship

X-ray of molar tooth before treatment

Note the wide, vertical bone loss associated especially with the mesial root that extends to the furcation area.   

molar tooth root treament successful

X-ray of molar tooth after 4 months review appointment

The lesion has healed and there has been bone in-fill.  The deep buccal and furcal periodontal pocket has completelyclosed without any periodontal intervention.  The patient has been referred back to his general dental practitioner for a coronal restoration.

Discussion:  A deep periodontal pocket associated with a tooth may be due to endodontic failure, root or tooth crack, and or periodontal disease.  The tooth must be vitality tested.  If the tooth is vital to cold testing and without an endodontic cause, periodontal treatment must be instituted.  The alveolar breakdown must be evaluated for design.  If the breakdown is wider coronally than apically we may assume it has a main perodontal component and treated as such.  In this case above, the lesion appears wider apically and narrows coronally, so it was assumed that the main cause was of an endodontic origin. The periodontal component could not be ruled out due to the open and wide periodontal pocket which was clinically located.  My patient was warned that the tooth may fail due to the added dimension of the periodontal component and the possibility of a crack in the tooth. 

 Summary:  A molar tooth presented with a periodontal component and abscess was treated with endodontic therapy alone.  My patient was explained the endodontic disease process and warned of the possible unfortunate outcomes.  The root canal treatment above resulted in a successful outcome.

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