(TC12) A Unique Case Report for Management of Complex Endodontic-Periodontal Combined Lesion

Combined endodontic-periodontal lesions provide unique treatment challenges. Intracanal and extraradicular biofilm must be eliminated for healing to occur. Treatment options often center on nonsurgical root canal therapy followed by periodontal therapy. However, with complex root morphology non-surgical periodontal treatment approaches may be unable to eliminate the extraradicular biofilm and surgical approaches become the treatment of choice. This case report highlights the use of multiple treatment modalities to address pulp necrosis, external cervical resorption (ECR), and a mesial root invagination associated with tooth #20. A 72-year-old female presented to the University of Texas Health Science Center at San Antonio Graduate Endodontic Clinic for evaluation of tooth #20. The tooth was diagnosed with pulp necrosis and chronic apical abscess. There was evidence of bone loss extending from the apex of the root to the mesial aspect due to a deep mesial radicular groove. Additionally, the cervical third of the root presented with ECR. Treatment was planned in two phases. In phase I, root canal treatment was initiated, double antibiotic paste was placed as an intracanal medicament for two months, and then the tooth was obturated. For phase II surgical repair of ECR, apicoectomy, and radicular groove debridement were accomplished extraorally via an intentional replantation approach. Follow-up appointment demonstrated resolution of signs and symptoms of apical periodontitis. Future follow up is warranted for bony healing. This case highlights how a combination of endodontic modalities can address both the endodontic and periodontal infections of a tooth with complex root morphology.