Endo-perio lesion (by Ilya Mer)

This patient referred for consult and treatment of #25 and #26 has come to my office with pain from his upper right  jaw and swelling against #25 and #26. RD has prepared both teeth for PFM and left them under provisional crowns. Percussion of both teeth were very painful, very high mobility (2-3 grade). There was a deep pocket (approximately 11-12mm) between molar and premolar. Vitality test was positive for molar and negative for premolar

Preoperative X-rays showed periradicular bone resorption and pocket depth, checked by guttapercha point
Preoperative image
After Cl&Sh procedures were completed calcium hydroxide dressing was placed for 4 weeks and it's filling quality checked by X-ray
The situation after 4 weeks. There were no signs of pain or swelling. 26 was still has positive reaction for cold test. Normal mobility of molar, premolar has 1-2 grade of mobility. The picture shows partial healing of the pocket.
During final obturation a small lateral canal was filled, perhaps this one caused periradicular bone destruction and join two microbiotas - endo and perio one. Elimination of the endodontic infection led to partial healing but for my view periodontal treatment is needed for the further repair.



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