Endodontic treatment enhances the regenerative potential of teeth with advanced periodontal disease with secondary endodontic involvement
A 55-year-old female presented with swelling and pus discharge on the labial aspect of the lower left first molar. The tooth had degree 1 mobility and was modestly positive (+7) according to the electric pulp test. The probing pocket depth was 10 mm at the distal sites. Radiographic images showed a wide and deep radiolucent lesion around the distal root. The diagnostic impression was a primary periodontal lesion with secondary endodontic involvement judged by the positive electric testing value with the wide periapical radiolucent lesion and deep probing depth. The treatment plan consisted of initial endodontic treatment followed by regenerative periodontal treatment. The swelling and pus discharge subsided after the endodontic treatment and root planing; however, the deep pockets on the distal root area remained given that the primary periodontal disease had not yet been fully managed. Regenerative periodontal therapy was scheduled to fill in the remaining defects following the endodontic treatment. Open flap debridement with an anorganic bovine bone (BBP) graft was performed and the intraosseous lesion healed uneventfully. Nine months following the surgical intervention, the radiographic images showed significant bone filling around the distal aspect of the distal root. The optimal level of occlusal function was restored and the patient was satisfied with the final outcomes ( and ).