PMC4935913_01
Periodontal charting of the initial visit (a) and 24 months (b) after active periodontal treatment. The probing depths distal (buccal and oral) of tooth 36 were reduced from 12 mm to 4 mm. The mean CAL was reduced from 2.7 mm to 1.5 mm, while bleeding on probing and plaque level were reduced from 55% to 1% and 48% to 20%, respectively.
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The patient was generally in good health with good oral hygiene (Figure 1).
Microsurgical access flap and use of enamel matrix derivate to treat the defects at tooth 46 (a-f) and tooth 36 (g-i). After crevicular incision (a), the papillae were preserved and the flaps reflected buccally (b and h) and lingually (c and g) to gain access to the defect. The granulation tissue was removed and the root surfaced planed (d) and prepared (PrefGel, Straumann, Freiburg, Germany) before the enamel matrix derivative (Emdogain, Straumann, Freiburg, Germany) was applied (e). Photographs (f) and (i) show the primary wound closure, immediately after the surgery (f) and one week postoperatively (i).
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Regenerative periodontal therapy using a biological factor (Emdogain, Straumann, Freiburg, Germany) was performed 4 weeks after anti-infective therapy:first at the lower right site, followed by the lower left site (Figure 2).
Clinical photographs (a, b) and radiographic images of teeth 46 (c, d) and 36 (e, f) at the 6- month reevaluation. Periodontal defects on both teeth demonstrated radiographic gain of bone structure in comparison to the baseline visit (c, e) 6 months after regenerative periodontal treatment (d, f).
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Clinical and radiographic measurements at tooth 36 suggested regeneration of the periodontal structures with a gain clinical attachment of 9 mm (distobuccal) and 8 mm (distolingual), respectively (Figure 3).
Panoramic radiograph. The periodontal defects, especially at tooth 36, showed progressive periodontal healing 24 months after regenerative periodontal treatment.
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The healing of the periodontic-endodontic lesion showed long-term stability (Figure 4).
Concerted treatment steps for the treatment of teeth with periodontic-endodontic lesions. Following diagnosis, root canal treatment and nonsurgical periodontal treatment should be completed within 4 weeks. Following nonsurgical/RCT, regenerative therapy should be completed within 4-12 weeks. Maintenance is lifelong.
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The treatment of tooth 36 followed a concerted protocol, which included endodontic and periodontal treatment steps (Figure 5).