Endodontic treatment enhances the regenerative potential of teeth with advanced periodontal disease with secondary endodontic involvement
A 57-year-old male who had a chief complaint of dull pain in the upper right first premolar visited the Department of Periodontology, Pusan National University Dental Hospital. There was no remarkable systemic disease. A wide radiolucent lesion on the upper right first premolar was evident with a probing depth of 9 mm only in the palatal surface. The electric pulp testing result demonstrated a positive value (+8). The tooth was diagnosed as a primary periodontal lesion with secondary endodontic involvement based on the positive electric testing value with a wide periapical radiolucent lesion and deep probing depth. Accordingly, an intentional endodontic treatment plan was proposed, followed by regenerative periodontal treatment. At 3 months following the commencement of the intentional endodontic treatment, the palatal probing depth remained deep and a wide radiolucent lesion was still evident due to the untreated primary periodontal lesion. Regenerative periodontal treatment was scheduled to address the intraosseous defect without concern as to whether pulpal infection by periodontal treatment would occur. Upon flap reflection, an anorganic bovine bone (BBP, Oscotec Inc., Seoul, Korea) graft was placed into the lesion following palatal root debridement. Follow-up was performed every 3 months for 1 year. A radiographic image taken 1 year postoperatively showed a significant decrease in radiolucency suggestive of remarkable enhancement of the bone density around the affected region ( and ).