1.Root planning/Curettage/Flap surgey
2.Root conditioning/Local irrigation?
3. RCT
4. Crown
5. Extraction of hopeless tooth
Hello there Alok, hope you are well. This question has a lot of divisions and we could see a long debate. lets hope the followers give their valuable comments and share their knowledge.
In my personal experience and as far as my knowledge is concerned regarding the subject, endo-perio or perio-endo whichever the case, we must perform endodontic therapy of a tooth. Curretage or root surface debridement is for sure recommended in case there is severe periodontal condition. Local irrigation would be a part of our overall treatment planning and maybe done. As far as crown fabrication is concerned, that would depend on the size of the access we make for endodontic therapy. and well extraction would be of course the BEST option for a tooth which is hopeless.
I am attaching a link for you to have a look. Its an old article in dental update but quite sound and simple. Please share if you have something new,
Best wishes !
http://www.dental-update.co.uk/issuesThreeArticle.asp?aKey=51
Dear Dr, see this case report
ABSTRACT
We report a case of a type III periodontal-endodontic lesion (combined or true) in a 41-year-old female patient without systemic history. The patient was transferred from the Specialization Course in Periodontology at the Graduate School of the University of Chile due to a periapical lesion in the tooth 3.6. The prognosis for this type of lesion is uncertain, since it is necessary to perform endodontic and periodontal treatment, and the result depends more on the periodontal treatment. The piece was treated endodontically leaving intracanal medication based on 2% Chlorhexidine gel for 7 days. Once the tooth obturated, we gave the patient an appointment 3 months later for a control radiography. Currently, the tooth is completely asymptomatic, without mobility and with signs of repair.
http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0719-01072011000100006
Dear Dr, see this case report
ABSTRACT
We report a case of a type III periodontal-endodontic lesion (combined or true) in a 41-year-old female patient without systemic history. The patient was transferred from the Specialization Course in Periodontology at the Graduate School of the University of Chile due to a periapical lesion in the tooth 3.6. The prognosis for this type of lesion is uncertain, since it is necessary to perform endodontic and periodontal treatment, and the result depends more on the periodontal treatment. The piece was treated endodontically leaving intracanal medication based on 2% Chlorhexidine gel for 7 days. Once the tooth obturated, we gave the patient an appointment 3 months later for a control radiography. Currently, the tooth is completely asymptomatic, without mobility and with signs of repair.
http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0719-01072011000100006
Dr please kindly provide more information on the case with regard to case history systemic status age and previous treatment undertaken for planning appropriate treatment. All the best. However there is need for multidisciplinary management.
dear Subash I just wanted a general opinion for treatment options for such cases
Treatment plan in such cases is dictated by the extent of pathological damage...In severe cases both RCT and curettage should be performed. Whereas, provision of crown should be only considered when, infection/inflammation is completely resolved and tooth becomes asymptomatic with radiographic signs of repair.
In the words of the late dentists Emilio Sargenti and Jacque Cain of Cincinnati, 'Treat the perio , then do the endo ( if necessary)".
It is very important to distinguish between paro-endo and endo-paro-cases, because endo-paro-cases can be treated with more success, also in a very hopeless stade. In this cases it is a must "treat the endo, then do the perio". First you have to exclude the fracture of a root, which produces also a endo-paro-lesion, but without a hope of healing.
This articles may help:
Günther Stöckl: Endo-Paro-Läsionen, Grundlagen und Fallbeispiele; Endodontie 2015, 24(1), p.53-62)
Christine Theile: Behandlung eines zweiten Unterkiefer-Molaren mit Endo-Paro-Läsion, Ein Fallbericht; Endodontie 24(3), p. 279-284
The healing of an endodontic lesion is more predictable while the repair or regeneration of periodontal tissues is questionable so start with endodontic therapy and follow with periodontal pocket elimination procedures
what timing protocol do you use for endo-perio lesions? First endo, then wait for 2-3 months?
This is how I manage the endoperio cases that come to me:
1. SRP
2. RCT
3. SRP
4. Periodontal flap surgery if required
5. Crown
in that sequence
* Extraction only if the prognosis is hopeless
The follow-up period for the need for periodontal flap surgery would be at 1 month and 3 months interval depending upon the periodontal destruction (mainly assessed by the status of tooth mobility, loss of attachment, and furcation involvement).
Hope it helps.
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