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A novel procedure to process extracted teeth for immediate grafting as autogenous dentin in combined endo-perio lesions- a case series

Author: 
Dr. Cherry Chamria, Dr. Roshani Thakur and Dr. Arvind Shetty
Subject Area: 
Health Sciences
Abstract: 

Background: Endodontic-periodontal combined lesion is a clinical dilemma because making a differential diagnosis and deciding a prognosis are difficult. Lesions of the periodontal ligament and adjacent alveolar bone may originate from infections of the periodontium or tissues of the dental pulp. Peri-radicular bone loss secondary to endodontic pathos is typically seen in teeth with necrotic pulps. The ultimate goal of periodontal therapy is not only to maintain the natural dentition, but also to restore lost periodontium. Combined periodontal and endodontic diseases involve the periodontal attachment apparatus. The treatment of endodontic-periodontal combined lesions requires both endodontic therapy and periodontal regenerative procedures. With advancements in new techniques and materials different treatment choices are available, providing a superior prognosis. This article includes case reports of combined endo-periolesions which were first treated with conventional endodontic therapy and then followed by periodontal surgery. This combined treatment resulted in a radio graphical evidence of alveolar bone gain. This case report demonstrates that proper diagnosis, followed by removal of etiological factors and utilizing the combined treatment modalities will restore health and function to the teeth with severe attachment loss caused by an endo-perio lesion. Extracted teeth are considered a clinical waste and therefore being discarded. It is evident that the clinical composition of dentin is similar to bone. The method for regeneration of the periodontal apparatus in the below given case series used extracted teeth from the respective patients. Aim: To manage the endodontic periodontal lesion with Grade 2 mobility using natural tooth as bone graft. Case description: 3 cases with combined endodontic periodontal lesion were explained. The appropriate management and outcome for each case was elaborated and justified. Discussion: In all the 3 cases, patient presented with established chronic secondary disease. Hence all the cases were planned to complete the endodontic therapy initially and then were preceded with periodontal therapy such as open flap debridement and bone graft. For these cases, autogenous bone graft using patients natural tooth was used. Conclusion: Treatment outcome found with 9 monthly follow-up was satisfactory. Mobility was reduced from grade 2 to almost no mobility. The radiographic changes were appreciable.

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