Method: 43 patients, with primary endodontic lesion and secondary periodontal involvement were treated by microscopic technique of root canal treatment. The diagnostic criteria are 1. a clear source of endodontic-originated infection; 2. pulp necrosis; 3. periodontal pocket depth of 7 to 10 mm in at least one site; 4. periodontal soft tissue inflammation such as periodontal abscess and/ or sinus tracts; 5. mobility I~ II degree; 6. periapical lesion and/or furcation involvement and/or external root resorption radiographically. All patients were treated by microscopic techniques of root canal treatment, including root canal ultrasonic cleaning under dental microscope, calcium hydroxide root canal medication for 4 weeks, and thermal gutta-percha canal obturation. The pulp chamber floor was sealed by dentin bonding to prevent invasion of bacteria and their by-products to the furcation root area through accessory canals. Periodontal therapy was performed by supergingival scaling to remove supragingival plaque and calculus. Patients were followed-up at least 12 months.
Result: Thirty-seven patients were followed-up at 12 months. Radiographic examination showed complete healing of the periradicular and furcation lesion in these patients. Probing periodontal pocket depths decreased to 1 to 3mm (mean 2.5 mm), and no obvious mobility was detected.
Conclusion:
The microscopic root canal therapy alone may result in complete healing of pulpal-periodontal lesions. Further studies on large sample are warranted.
Clinical Significance: Accurate diagnosis can be achieved by careful history taking, examination and the use of special tests. It is important that the dentist recognizes and is familiar with canal ramifications and variations. The microscopic technique of root canal treatment is predictable and effective for pulpal-periodontal lesions.