Endodontic treatment enhances the regenerative potential of teeth with advanced periodontal disease with secondary endodontic involvement
A 33-year-old male visited our periodontal clinic with a chief complaint of persistent dull pain on the lower left second molar on chewing and biting. The clinical condition was characterized by deep pocket depths ranging from 9 to 12 mm on the midbuccal and distal area, without a noticeable mobility or suppuration upon gentle probing. The result of the electric pulp tests indicated that the second molar was vital (+7), and the radiographic image revealed a circumferential radiolucency surrounding the distal root apex. The diagnostic impression was a primary periodontal lesion with secondary endodontic involvement based on a positive electric testing value with a wide periapical radiolucent lesion and deep probing depth. Intentional endodontic treatment followed by regenerative periodontal treatment was planned. Three months after the endodontic treatment, the guided tissue regeneration was performed for the resolution of the primary periodontal intraosseous lesion. The guided tissue regeneration consisted of the placement of a nonresorbable (expanded polytetrafluoroethylene) barrier membrane (Goretex, W.L. Gore and Associates, Newark, DE, USA) with anorganic bovine bone (BBP) graft. The membrane was removed at 6 weeks postoperatively. The lesion healed uneventfully and a radiograph taken at more than 6 months following the regenerative surgery demonstrated remarkable osseous repair and an enhanced radiopacity ( and ).