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Objective@#To investigate the clinical characteristics, diagnosis and treatment of severe combined periodontal-endodontic lesions in a double-rooted maxillary lateral incisor with a palatal radicular groove and to provide a reference for clinical diagnosis and treatment.@*Methods@#A patient with a double-rooted left maxillary lateral incisor with a palatal radicular groove and severe combined periodontal-endodontic lesions underwent complete root canal therapy and intentional replantation, and a retrospective analysis of the management of this type of patient was performed based on the literature.@*Results@#The 3-year follow-up examination revealed no discomfort, good healing of the upper left lateral incisor, no pathological loosening, and a palatal gingival sulcus was found at a depth of approximately 1 mm. Review of the literature showed that the prognosis of the affected tooth and the choice of treatment plan were correlated with the length and depth of extension of the lingual groove toward the root, the periodontal condition and the pulpal status of the affected tooth. For minor PRGs or for affected teeth with no loss of pulpal viability, flap surgery and odontoplasty can be used to avoid endodontic treatment or retreatment. For deep or long lingual grooves that result in significant loss of periodontal tissue, endodontic treatment, odontoplasty, or closure of the grooves and guided tissue regeneration are needed. In the case of PRGs with double root formation, the affected tooth can be preserved via root canal therapy, removal of the small root and filling with apical restorative material, and intentional replantation.@*Conclusion@#In cases of severe combined periodontal-endodontic lesions due to palatal radicular grooves occurring in double-rooted maxillary lateral incisors, clinical presentation and imaging can prevent missed diagnoses, and appropriate treatment should be based on the length and depth of lingual grooves extending toward the roots, periodontal conditions, and pulpal status of the affected teeth.
ABSTRACT
Palatal radicular groove is a developmental malformation of maxillary incisors, lateral incisors in particular, which often causes periodontal destruction. This paper reports a case of combined periodontal-endodontic lesions induced by palatal radicular groove, which was initially misdiagnosed as a simple periapical cyst. After root canal therapy and periapical cyst curettage, the course of disease was prolonged, resulting in the absence of buccal and maxillary bone plates in the affected tooth area. After the etiology was determined, the affected tooth was extracted and guide bone tissue regeneration was performed at the same time, followed by implantation and restoration at the later stage, leading to clinical cure. The palatal radicular groove is highly occult, and the clinical symptoms are not typical. If the abscess of the maxillary lateral incisor occurs repeatedly, and the abscess of the maxillary lateral incisor has not been cured after periodontal and root canal treatment, cone-beam computed tomographic and periodontal flap surgery should be considered.
Subject(s)
Humans , Incisor , Radicular Cyst , Abscess , Tooth Root/abnormalities , Root Canal Therapy , Maxilla , CystsABSTRACT
Objective@#To study the distribution of pathogenic infection and relevance in combined periodontal-endodontic lesions of periodontal origin,and provide the basis for clinical treatment. @*Methods@#Totally 43 cases of combined periodontal-endodontic lesions of periodontal origin from Jan. 2018 to Jun. 2020 treated in the hospital were selected, including a total of 43 teeth as the experimental group. Another 41 teeth from 41 cases with severe periodontitis during the same period were set as the control group. subgingival plaque samples and root canal samples of ill teeth were made for test. Quantitative Real-time PCR was used to detect the quantity of Tannerella forsythia (Tf), Porphyromonas gingivalis (Pg), Fusobacterium nucleatum (Fn), Prevotella intermedia (Pi), Treponema denticola (Td), Digestive streptococcus (Ds), Enterococcus faecalis (Ef), Porphyromanus endodontics (Pe). @*Results@# There was no significant difference in the quantity of Digestive streptococcus and Porphyromanus endodontics in the root canal tissue and subgingival plaque of the experimental group (Ρ>0.05), other six pathogenic bacteria in the subgingival plaque samples was significantly higher than that from the root canal tissue (P<0.05); No significant difference in the quantity of Digestive streptococcus was found in the subgingival plaque between the two groups (P=0.241). Other seven pathogenic bacteria in the subgingival plaque samples of the experimental group was significantly higher than that from the control group (P<0.05); The number of Ef, Pe, Pg, Td and Tf in the root canal tissue was closely related to the subgingival plaque in the experimental group, Ef (r=0.347, Ρ < 0.05), Pe (r=0.363, Ρ < 0.05), Pg (r=0.437, Ρ < 0.01), Td (r=0.471, Ρ < 0.01), Tf (r=0.679, Ρ < 0.01).@*Conclusion @# The quantity of common pathogenic bacteria in the root canal tissue of Combined periodontaI-endodontic lesions of periodontal origin was lower than that from the subgingival plaque sample, and the quantity of common pathogenic bacteria in the root canal tissue was closely related to the subgingival plaque. During clinical treatment, attention should be paid to the control of pulp tissue infection while controlling periodontal tissue infection.
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Objective: This literature review aims to assess the causes and consequences of periodontal-endodontic lesions, as well as its clinical, radiographic and microbiological aspects. Literature review: Periodontal-endodontic lesions are often changes that affect all teeth due to the close relationship between pulp and periodontium. Many authors researched about this, but there are many disagreements on the subject, starting with the different types of classification, in which many are based on the origin of the disease, the other forms of treatment, degree of pulp involvement, among others, with the purpose of helping in the correct diagnosis. The knowledge of the etiology of the disease is extremely important, because the success of the treatment depends on the rapidity of its onset, the treatment protocol adopted and medication use. Conclusion: It is necessary that the dentists know the morphology and structure of the oral cavity, as well as the knowledge of all factors that can cause the same damage, so that they differentiate the types of periodontalendodontic lesions regarding to its origin, defining the best treatment to be followed.
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Objective To compare the bacterial community profiles present in periodontium and root canals of the same tooth diagnosed as combined periodontal-endodontic lesions by using denaturing gradient gel electrophoresis (DGGE).Methods Samples were collected from 13 extracted teeth with advanced periodontitis,endodontic samples from root tip 1/3 root canal,and periodontal samples from the corresponding neighboring periodontium.Genomic DNA was collected for the following universal bacterial primersPCR.The PCR products were then loaded on the DGGE gels to gain separate bands.The typical DGGE bands were excised,PCR-cloned and sequenced.Results The number of bands,which was indicative of the number of bacterial species,was compared intra-group (periodontal and pulpal specimen from the same tooth).The difference was statistically significant (P＜0.01),but there was no positive correlation between them.The similarity (Dice Coefficient) between them was 13.1％-62.5％.Taxa identified through BLAST (≥98％ identity) were Campylobacter,Fusobacterium,Neisseria,et al in the periodontium,and Mogibacterium,Corynebacterium,Actinomyces,et al in the root canals.Conclusion Common bacteria existed between them,but not all of the periodontal bacteria would appear in neighboring root canal; and the bacteria in the root canal are not completely from neighboring periodontal tissue.The original bacteria in the root canals may resuscitate and enrich the bacterial community.In combined periodontal-endodontic lesions (periodontal source),it is probable that new species existed to be confirmed either in the periodontium or in the root canal.