Regenerative Endodontic Procedure for Mature Permanent Molar with Endo-periodontal Lesion

Objectives: Endo-periodontal lesion (EPL) severely compromises the prognosis of the tooth, presenting as one of the most challenging clinical situation. Generally, tooth with EPL was treated by root canal treatment (RCT) with subsequent non-surgical periodontal therapy. Recently, regenerative endodontic procedure (REP) has been introduced into treatment of mature permanent tooth with necrotic pulp and/or apical periodontitis. In this study, we present a unique case of mature permanent molar with EPL caused by periodontitis. This tooth was treated with non-surgical periodontal therapy and REP using concentrate growth factor (CGF) as a scaffold.
Methods: A 43-year-old male patient presented with a painful loose lower molar. Clinical examination showed mobile tooth #30 which had no response to pulp vitality tests. The tooth had no root fracture or perforation but had deep periodontal pockets reaching to the apex of the buccal, lingual, and mesial root surfaces with attachment loss. Periapical radiolucency of mesial root and alveolar bone resorption with furcation involvement was found radiographically. The tooth 30 was diagnosed as grade 3 EPL without root damage in periodontitis patient. The treatment was initiated with pulp extirpation and apical foramen enlargement followed by root canal medication with calcium hydroxide. Scaling and root planning was performed within a week. At the 5-month follow-up visit, after removal of the calcium hydroxide, CGF was placed into the root canals with coronal temporary restoration. One month later, restoration was finalized with 3mm of MTA and composite-resin.
Results: At follow-up visits up to 18 months, the tooth showed reduction of periodontal pockets and no mobility. Radiographic examination revealed complete resolution of the periapical lesion and marked decrease of periodontal and furcation radiolucency.
Conclusions: Non-surgical periodontal therapy with REP using CGF could be a treatment alternative for the mature permanent tooth with EPL in periodontitis patients.