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The importance of correct diagnosis and treatment in endo-periodontal lesions: a two cases comparison Sara Bernardi Christian Frascarelli Giulia Fantozzi Silvia Caruso Robert Gatto Gianna Maria Nardi Maria Adelaide Continenza Dental Update 2024 43:8, 707-709.
Authors
SaraBernardi
DDS
Molecular and Ulstrastructure Imaging European PhD, Department Of Life, Health and Environmental Sciences, University of L'Aquila, Via Vetoio 2, Coppito 2, 67100, L'Aquila, Italy, (sara.bernardi@graduate.univaq.it)
This paper illustrates two endo-periodontal lesions treated with the same standardized protocols with different prognoses. In the first case, the endodontics and periodontal therapies were performed with clinical and radiological healing of the lesion. In the second case, the tooth had to be extracted because of repeated inflammatory processes. In order to investigate the reasons for failure, the extracted tooth was submitted to clearing process, followed by stereomicroscope observation. It revealed a vertical fracture running along the palatal root, not detectable by radiographic examination. This pathway between pulpal and periodontal tissues determined the negative prognosis of the treatment.
CPD/Clinical Relevance: This report aims to highlight how root vertical fractures may not be readily detectable to the standard bi-dimensional radiograph.
Article
The endo-periodontal lesion results from bacterial infection involving the pulp and the periodontal tissues. According to the most widely used classification, Simon's,1 these lesions are first divided into pulpal and periodontal lesions and further classified into five subcategories:
In 2014, Al-Fouzan2 proposed the following new method of classification, based on primary disease with secondary effects:
In the last category, the author cites the vertical root fractures resulting from trauma, as well as from the ‘cracked tooth syndrome’, and fractures spontaneously occurring on the root surfaces.
However, diagnosing a vertical root fracture by means of common bi-dimensional radiography is not so easy, and its misdiagnosis can be a reason determining the failure of treatment.3,4,5
The aim of this study was to illustrate how the standardized endo-periodontal treatment protocol and the patient's compliance was important in the healing of the teeth tissues with a correct diagnosis.
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