Oral multidisciplinary considerations for clinical strategies of endodontic microsurgery / 口腔疾病防治

@#Endodontic microsurgery is a vital treatment modality for teeth with persistent periradicular pathoses that have not responded to nonsurgical retreatment. The principle is to determine the reason for failure, completely eliminate the infection and promote periapical healing. Within recent years, endodontic microsurgery has evolved to become standardized and presents with a high success rate. However, its outcome is still influenced by many factors, including anatomy, periodontal condition, crown-to-root ratio, occlusion, the type of periradicular lesion, and prosthesis. Moreover, endodontists always concentrate on “the apex”, paying little attention to the general preoperative evaluation, accurate diagnosis, and comprehensive treatment plan. This article reviews the latest literature on these issues and the clinical experience of our research group and discusses the correlation between endodontic microsurgery and other oral disciplines, including periodontology, prosthodontics, oral implantology, oral and maxillofacial surgery and orthodontics. The oral interdisciplinary assessment should be made with comprehensive consideration of the root canal system, periradicular lesion, adjacent anatomical relationships, periodontal condition, occlusion, and esthetic rehabilitation. Based on these findings, the continuity of treatment will be optimized, and the best treatment plan will be proposed to provide clinical strategies for the diagnosis and treatment of complex periradicular diseases.

Etiologia das lesões endo-periodontais - uma visão para o diagnóstico clínico: uma revisão de literatura / Etiology of endo-periodontal lesions - a vision for clinical diagnosis: a literature review

O objetivo deste estudo é apresentar e discutir as principais etiologias das lesões endo-periodontais com intuito de auxiliar o Cirurgião-dentista na busca de um correto diagnóstico clínico e posterior tratamento. Foram coletados dados na literatura, pertinentes ao assunto, nas plataformas de busca de dados Crochane, Medline, PubMed e Scielo, contendo artigos científicos no período de 01/2002 até 06/2019, nos idiomas inglês e português. Com isso, os resultados dessa busca foram selecionados pelos seguintes critérios: estudos abrangendo a etiologia das lesões endo-periodontais, estudos com metodologias e resultados claros, objetivos e pesquisas in vivo ou in vitro devidamente estruturadas e com resultados relevantes para a comunidade científica. Os critérios de exclusão foram os artigos que não apresentassem nenhum dos objetivos a serem pesquisados. Assim, os resultados encontrados no estudo foram: 73 artigos, incluídos 23 artigos e 50 artigos excluídos. As etiologias das lesões endo-periodontais estão relacionadas a diferentes alterações patológicas nos tecidos pulpares e/ou periodonto, entre elas pode-se considerar a anatomia dental, doença periodontal, doença endodôntica, microbiota, cárie dentária, biofilme dental, trauma dental, reabsorções dentárias, tratamento endodôntico deficiente, fraturas, mal formações dentárias, iatrogênias, entre outros. Assim, o Cirurgião-Dentista deve estar atento às diversas etiologias para futuramente elaborar um diagnóstico e um plano de tratamento eficiente baseado na fonte de origem dessa lesão endo-periodontal (AU)

The objective of this study is to present and discuss the main etiologies of the endo-periodontal lesions in order to assist the dentist in the search for a correct clinical diagnosis and subsequent treatment. Data were collected from the Crochane, Google Scholar, Medline, PubMed and Scielo data search platforms, containing scientific articles from 01/2002 to 06/2019, in the English and Portuguese languages. The results of this search were selected according to the following criteria: studies covering the etiology of endo-periodontal lesions, studies with clear methodologies and results, objectives and in vivo or in vitro research, duly structured and with relevant results for the scientific community. Exclusion criteria were articles that did not present any of the objectives to be investigated. Thus, the results found in the study were: 73 articles, including 23 articles and 50 excluded articles. The etiologies of the endo-periodontal lesions are related to different pathological alterations in the pulp and / or periodontal tissues, among them the dental anatomy, periodontal disease, endodontic disease, microbiota, dental biofilm, dental trauma, dental resorption, poor endodontic treatment, fractures, dental malformations, iatrogenes, among others. Thus, the Dentist should be aware of the different etiologies in order to elaborate a diagnosis and an efficient treatment plan based on the source of the endo-periodontal lesion. (AU)

Cemental tear: An unusual cause for persisting endodontic periodontal lesion

Cemental tear represents a rare form of root surface fracture which makes teeth prone to periodontal breakdown. The diagnosis of cemental tear becomes a challenge as it is usually neglected or misdiagnosed and is also underreported in the literature. Correct diagnosis and early treatment of cemental tear can prevent further periodontal breakdown and may preserve the affected tooth for a longer duration. This case presents the diagnosis, treatment, and an analysis of a right maxillary lateral incisor with an improper endodontic treatment coupled with a cemental tear. Despite surgical removal, the cemental tear led to the development of an endodontic periodontal lesion. This article intends to help recognize early signs and symptoms of cemental tear and establish timely diagnosis. It determines that if the periodontal destruction caused by cemental tears is diagnosed and treated early, it may be possible to prevent further periodontal breakdown and preserve the tooth for a longer period.

Diagnóstico e prognóstico de lesões endoperiodontais: uma revisão de literatura / Diagnosis and prognosis of endo-periodontal lesions: a literature review

The aim of the study was to analyze through an integrative review of the literature, the fear that patients experience in dental treatment, having the critical investigation aimed at the "Sistema Único de Saúde" (Brazilian Public Health System). One of the challenges reported by dental surgeons is the angst that part of the patients feel during treatment, when going through the procedures. This review's main objectives were to point out how this fear occurs and describe the consequences of this condition and how to prevent it. The research for scientific papers strategy was carried out through the site "portal de periódicos da BVS" (Portal of Journals on Health Sciences). All the publications that had the keyword "Ansiedade ao Tratamento Odontológico" (Dental Treatment Anxiety) were consulted. Thus, the search was refined through free scientific papers, with full text in English, with the main subject being the fear of dental treatment, between the years of 2013 and 2017. There were accounts related to the fear of dentist at both biological and psychological spheres, which as a consequence increases the absenteeism in the appointments leading to the worsening of the oral condition of the patient. Therefore, this article suggests that dentists acquire a multidisciplinary qualification, thus allowing them to deal with the psycho-social aspects inherent and integral of each individual. (AU)

The objective is to present and discuss, through a literature review, studies that point to a diagnosis and prognosis in endo-periodontal sclerosis. It was a research in the literature, in the databases: Crochane, Google Academic, Medline, PubMed and Scielo, with scientific articles from 2007 to 2018, in the English and Portuguese languages, using the search terms: "Diagnostic AND/OR "Endodontics" AND/OR "Endo-periodontal lesion AND/OR "Periodontics". Case studies, case control, clinical research, in vitro and in vivo studies, and systematic and systematic reviews of a diagnostic program were selected and followed. The success of surgery is important to be successful in treatment. For this purpose, the assay may be used and / or the clinical exams so that there is no pathology that is affecting the patient. These procedures are: anamnesis, clinical examination, visual examination of soft and hard tissues, radiographic, dental and periodontal probing, palpation, dental mobility, percussion, microbiological examination, tests for fistula processing and pulp sensitivity, and in cases of doubt, exposure surgery. The prognosis will vary according to the diagnosis of the lesion, an individual's response and a need for reintervention. Therefore, diagnosis and prognosis are essential for the treatment of endo-periodontal lesions. (AU)

O estudo teve como objetivo analisar descritivamente por meio de revisão de literatura integrativa, o medo de pacientes frente ao tratamento odontológico, com a investigação crítica voltada para o Sistema Único de Saúde (SUS) Brasileiro. Um dos obstáculos relatados, por cirurgiões-dentistas, nas consultas odontológicas é o medo que uma parcela dos pacientes apresenta frente aos procedimentos durante as sessões de atendimento. Procurou-se apontar como o medo se manifesta e descrever as consequências e prevenção desta condição. A busca dos artigos foi realizada no portal de periódicos da BVS e todas as publicações que continham o descritor em Ciências da Saúde "Ansiedade ao Tratamento Odontológico" foram consultadas. Não obstante, a busca foi refinada para periódicos com texto completo disponível e no idioma português, com o assunto principal o medo frente ao tratamento odontológico, entre os anos de 2013 a 2017. As manifestações relacionadas ao medo de dentista no campo biológico e psicológico têm como consequência a abstenção às consultas odontológicas e a piora da condição bucal dos usuários. Cabe aos profissionais conhecer de maneira ampla os seus pacientes para que consigam lidar com os aspectos psicossociais inerentes e indissociáveis a esses indivíduos (AU)

Falsas vías en pacientes atendidos en la Facultad de Estomatología de La Habana / False pathways in patients treated at the Faculty of Dentistry of Havana

RESUMEN Introducción: la falsa vía es la apertura artificial en las paredes del conducto debido a penetración de la dentina; lo que provoca comunicación entre el espacio pulpar y el periodonto. Estos accidentes suelen ocurrir durante la realización de tratamientos endodónticos o al preparar el lecho para colocación de pernos. Esto provoca daño al periodonto, pudiendo desarrollarse bolsas periodontales. Objetivo: identificar la frecuencia de estos accidentes, y determinar su asociación con la presencia de periodontitis. Materiales y métodos: se realizó un estudio descriptivo y transversal en la Facultad de Estomatología de La Habana, entre enero de 2011 y enero de 2016. El universo estuvo constituido por 50 dientes con falsa vía, correspondientes a 50 pacientes. La información se obtuvo a través de: interrogatorio, examen clínico, radiografías e historias clínicas, previo consentimiento de los pacientes. Se procedió al llenado de un formulario confeccionado al efecto. Resultados: el 52,0 % de falsas vías correspondió al grupo de 35 a 59 años, los dientes más afectados fueron los incisivos, con 40,0 %. El 60,0 % de las perforaciones fueron ocasionadas por terapia endodóntica. Se detectó periodontitis en el 30,0 % de los dientes perforados. Conclusiones: las falsas vías fueron predominantes en el grupo de edad de 35 a 59 años, los incisivos fueron los dientes más afectados, la mayoría de las lesiones se produjo durante la terapia endodóntica. Más de la cuarta parte de las lesiones estuvo asociada a periodontitis (AU).

ABSTRACT Introduction: the false way is the artificial opening in the walls of the conduit due to penetration of the dentin; which causes communication between the pulp space and the periodontium. These accidents often occur during endodontic treatments or when preparing the bed for bolt placement. This causes damage to the periodontium, and periodontal pockets may develop. Objective: to identify the frequency of these accidents, and to determine their association with the presence of periodontitis. Materials and methods: a descriptive and cross-sectional study was carried out in the Faculty of Dentistry of Havana, between January 2011 and January 2016. The universe consisted of 50 teeth with false pathway, corresponding to 50 patients. The information was obtained through: interrogation, clinical examination, radiographs and medical histories, with the consent of the patients. A completed form was filled out. Results: 52,0 % of false pathways corresponded to the group of 35 to 59 years, the teeth most affected were the incisors, with 40,0 %. 60,0 % of the perforations were caused by endodontic therapy. Periodontitis was detected in 30,0 % of the perforated teeth. Conclusions: the false pathways were predominant in the age group of 35 to 59 years, the incisors were the most affected teeth, most of the lesions occurred during endodontic therapy. More than a quarter of the lesions were associated with periodontitis (AU).

Relationship between alcoholism addiction and periodontitis. an in vivo study using drinking-in-darkness protocol in rats

Periodontal disease (PD) has been considered a probable risk factor for several systemic diseases. among them, PD is presumed to be one of the possible etiologies of chronic illness of the central nervous system. In this context, poor oral health and PD is associated with substance abuse in humans. however, if periodontal lesions can produce addiction is unknown. this paper aims to evaluate the possibility that chronic periodontal injury (CPL) can cause ethanol binge intake in drink-in-darkness (DID) protocol in rats. in CPL group (n=10) experimental damage was done to the periodontal tissue of the second maxillary molar, the control group (n=9) received sham injury. forty-three days after CPL the intake of ethanol was assessed using several concentrations in DID experiment. during the DID experiment, we observed significant differences between the binge-type consumption of ethanol at the lowest concentration of 10 percent (p=0.01). differences in consumption of 20 percent ethanol are observed during a few days (p=0.04), and there are no differences in consumption at 40 percent concentration of ethanol (p=0.2). it is concluded that chronic periodontal lesion leads to alcoholism in wistar rats.

Microbiota das infecções endo-periodontais: uma revisão de literatura / Microbiota of endo-periodontal infections: a literature review

O objetivo desse estudo é revisar a literatura acerca da microbiologia presente nas doenças endoperiodontais e assim apresentar um melhor conhecimento ao clínico frente à patologia a ser tratada. Foi realizada uma busca nas plataformas: Google Acadêmico, Pubmed e Scielo. Foram selecionados artigos de 2007 até 08/2018, em língua inglesa e língua portuguesa, com os termos: "Endodontia" E/OU "Lesão endoperiodontal E/OU "Microbiologia oral" E/OU "Periodontia". Os principais resultados encontrados demonstraram uma grande variedade microbiológica associada às lesões endoperiodontais e ainda, a presença de alguns microrganismos de difícil eliminação. Na lesão endodôntica primária: Enterococcus faecalis, Parvinonas micra, Mogibacterium timiduam, Filifactor alocis, Fretibacterium fastidiosum, Parvinonas micra, Streptococcus constellatus, Eubacterium brachy, Tannerella forsythia. Anaeróbios estritos: Veillonella parvula, Porphyromonas gingivalis, Propionibacterium acnes, Lactobacillus acidophilus, Campylobacter rectus, Slackia exigua, Anaeróbios facultativos: Bactérias microaerofílicas: Aggregatibacter actinomycetemcomitans. Lesão endodôntica primária com envolvimento periodontal secundário: Enterococcus faecalis, Parvinonas micra, Mogibacterium timiduam, Filifactor alocis, Fretibacterium fastidiosum, Streptococcus constellatus, Eubacterium brachy, Tannerella forsythia; Lesão periodontal primária: Porphyromonas gingivalis, Fusobacterium nucleatum, Eikenella corrodens Fusobacterium nucleatum, Treponema denticola, Tannerella forsythia, Prevotella intermedia, Parvimonas micra. Lesão periodontal primária com envolvimento endodôntico secundário: Bacteroidaceae sp., Fretibacterium fastidiosum. Lesão endoperiodontal verdadeira combinada: Tannerella forsythia, Porphyromonas endodontalis, Aggregatibacter aphrophilus, Peptostreptococcus stomatitis, Veillonella rogosae, Campylobacter rectus, Campylobacter concisus, Neisseria elongata; Veillonella rogosae, Fusobacterium canifelinum, Haemophilus parainfluenzae, Peptostreptococcus stomatitis, Peptostreptococcus stomatitis, Enterobacter asburiae, Aggregatibacter aphrophilus, Campylobacter rectus, Corynebacterium matruchotii, Neisseria bacilliformis, Actinomyces odontolyticus, Mogibacterium timidum. Conclui-se que o cirurgião-dentista deve melhor identificar qual a microbiota presente em cada tipo de patologia endoperiodontal para que consiga realizar os tratamentos com eficiência obtendo o sucesso(AU)

The objective of this study is to review the literature about the microbiology present in endodontic diseases and thus to present a better knowledge of the clinician regarding the pathology to be treated. By searching the platforms: Google Scholar, Pubmed and Scielo. Articles from 2007 to 08/2018, in English and Portuguese, were selected using the terms: "Endodontics" AND/OR "Endo-periodontal lesion AND/OR" Oral Microbiology "AND/OR" Periodontics ". The main results of the search were a large microbiological variety associated with endo-periodontal lesions and the presence of some microorganisms that were difficult to eliminate. Primary endodontic lesion: Enterococcus faecalis, Parvinonas micra, Mogibacterium timiduam, Filifactor alocis, Fretibacterium fastidiosum, Parvinonas micra, Streptococcus constellatus, Eubacterium brachy, Tannerella forsythia. The primary endodontic lesions with secondary periodontal involvement are: Enterococcus faecalis, Parvinonas micra, Mogibacterium timiduam, Filifactor alocis, Fretibacterium, Agrigatibacter actinomycetemcomitans, Staphylococcus aureus, Campylobacter rectus, Campylobacter rectus, Slackia exigua fastidiosum, Streptococcus constellatus, Eubacterium brachy, Tannerella forsythia. Primary periodontal lesion: Porphyromonas gingivalis, Fusobacterium nucleatum, Eikenella corrodens Fusobacterium nucleatum, Treponema denticola, Tannerella forsythia, Prevotella intermedia, Parvimonas micra; Primary periodontal lesion with secondary endodontic involvement: Bacteroidaceae sp., Fretibacterium fastidiosum. True endo-periodontal lesion combined: Tannerella forsythia, Porphyromonas endodontalis, Aggregatibacter aphrophilus, Peptostreptococcus stomatitis, Veillonella rogosae, Campylobacter rectus, Campylobacter concisus, Neisseria elongata;Veillonella rogosae, Fusobacterium canifelinum, Haemophilus parainfluenzae, Peptostreptococcus stomatitis, Peptostreptococcus stomatitis, Enterobacter asburiae, Aggregatibacter aphrophilus, Campylobacter rectus, Corynebacterium matruchotii, Neisseria bacilliformis, Actinomyces odontolyticus, Mogibacterium timidum.It concludes that the dental surgeon must identify which microbiota is present in each type of endo-periodontal pathology, so that he can perform the treatments efficiently, achieving success. (AU)

Intentional replantation for the treatment of palatal radicular groove with endo-periodontal lesion in the maxillary lateral incisor: a case report / 华西口腔医学杂志

Palatal radicular groove leads to severe endo-periodontal lesion in lateral incisors. The groove occurs on the labial and lingual root surfaces, while the localized periodontal pocket develops along the lingual groove length. The complicated root canal system, extensively destroyed bone lamella, and persistent fistula pose a challenge for root canal therapy, tooth retention, and thorough infection control inside and outside of the root canal. Combining microscopic root canal therapy with intentional replantation and nano-biomaterial application facilitates infection control, tooth retention, and formation of newly periodontal attachment.

Expression and effect of S100A9 in the periodontium of diabetic rats / 华西口腔医学杂志

<p><b>OBJECTIVE</b>The study seeks to investigate the expression of S100A9 and its potential role in periodontal diseases induced by diabetes.</p><p><b>METHODS</b>A diabetic SD rat model was established through intraperitoneal injection of streptozotocin (STZ). Hematoxylin-eosin (HE) staining was performed to study the structure of the periodontium of diabetic rats. Using immunohistochemical staining, the distribution of S100A9 expression was detected in the periodontium of diabetic rats. Ex-pressions of Toll-like receptor 4 (TLR4) (ligands of S100A9) and p-P65/nuclear factor κB (NF-κB) were also measured.</p><p><b>RESULTS</b>The trabecular structure of alveolar bone was sparser, and lamina dura was disappeared in diabetic rats. Obviously higher expressions of S100A9 were observed in the periodontal ligament, alveolar bone, and gingival epithelial of diabetic rats than in the control rats. TLR4 expressions in the periodontal ligament, alveolar bone and gingival epithelial of the diabetic rats were also higher as compared to the control rats. p-P65 expression was not detected in the control rats, but was detected in the periodontal ligament and alveolar bone of the diabetic rats.</p><p><b>CONCLUSIONS</b>Periodontium lesions in diabetes mellitus may be induced by the activation of TLR4 and NF-κB signaling pathway meditated by S100A9. 
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Reparación de una lesión endoperiodontal mediante tratamiento endodóntico no quirúrgico: reporte de un caso / Repair of an endo-periodontal lesion using a non-surgical endodontic treatment approach: report of a case

El tratamiento y pronóstico de las lesiones endoperiodontales depende del diagnóstico oportuno y preciso de la enfermedad endodóntica y/o periodontal. Cuando se trata de lesiones endodónticas primarias con involucración periodontal secundaria, la estrategia de tratamiento debe ser primeramente enfocada a la infección pulpar, al debridamiento y desinfección de los conductos radiculares. El objetivo de este estudio es demostrar la capacidad de reparación de una lesión endoperiodontal mediante terapia endodóntica no quirúrgica, sin posterior terapia periodontal. El caso es un paciente masculino de 10 años con necrosis pulpar del órgano dentario 46 con involucración periodontal mediante lesión en furca, la cual reparó completamente en tres meses tras el tratamiento endodóntico. Estos hallazgos se confirman radiográficamente y por la disminución de la profundidad sondeable en la zona de la lesión. Se concluye que en este tipo de casos, con involucración endodóntica primaria, la necesidad del tratamiento periodontal quirúrgico o no quirúrgico será determinada exclusivamente por la falta de reparación de la lesión por largos periodos de tiempo.

he treatment and prognosis of endo-periodontal lesions depend on the timely and accurate diagnosis of the endodontic and/or periodontal disease. In the case of primary endodontic lesions with secondary peri-odontal involvement, the treatment strategy should be focused primarily on the pulp infection and the debridement and disinfection of root canals. The aim of this study is to demonstrate the repair capacity of an endo-periodontal lesion treated with nonsurgical endodontic root therapy and no subsequent periodontal treatment. The case involves a 10-year-old male patient with pulpal necrosis and apical periodontitis of tooth 46; periodontal furcation involvement was also evident. The diagnosis was a primary endodontic lesion with secondary periodontal involvement. The furcation defect healed completely within three months of non-surgical root canal treatment, a fact confi rmed by X-rays and by the reduction in the probing depth in the area of the lesion. We conclude that in cases such as this, where there is primary endodontic involvement, surgical or non-surgical periodontal treatment should be considered exclusively if the periodontal lesion persists for long periods of time.

Management of failed periodontal surgical intervention for a furcal lesion with a nonsurgical endodontic approach

As long as the prognosis of teeth remains a matter of concern, the endodontic-periodontal relationship will be considered a challenge for the clinician. Many etiologic factors, including bacteria, fungi, and viruses, plus other contributing factors, such as trauma, root resorptions/perforations, and dental malformations, play a role in the co-occurrence of endodontic and periodontal lesions. Whatever the cause, a correct diagnosis on which to base the treatment plan is the key to successful maintenance of the tooth. This article reports the successful endodontic management of a furcation lesion in a mandibular molar that was nonresponsive to a previous periodontal surgical graft. The case had presented a diagnostic challenge for the clinicians, and this article reviews the key points that can lead to a correct diagnosis and treatment planning.

Referred dental pain, an analysis of their prevalence and clinical implication / Dolor dental referido, análisis de su prevalencia e implicancias clínicas

The study objective was to evaluate the prevalence of referred dental pain (RDP) in a group of Brazilians subjects and identify possible partnerships with sex, age and the presence of periodontal or periapical lesions. A descriptive cross-sectional study was designed, 98 patients between 14 and 64 years old (59 women and 39 men), who consulted by dental pain were evaluated clinically and radiographically in order to determine the cause and partnership with periapical and periodontal lesions and its possible territories projection other than their origin. The prevalence of RDP was 31.6 percent, higher in women (67.74 percent) though without statistical significance. The RDP was presented at a 45.16 percent together with periapical lesion and a 25.8 percent along with periodontal lesion. There was no relationship between age and RDP presence. The high prevalence of RDP found reinforces the need for a diagnosis of orofacial pain.

El objetivo de este estudio fue analizar la prevalencia de dolor referido dental (DRD) en un grupo de sujetos brasileros y determinar las posibles asociaciones con sexo, edad y la presencia de lesión periapical o periodontal. Se diseñó un estudio descriptivo de corte transversal, con 98 pacientes, de entre 14 y 64 años (59 mujeres y 39 hombres), que consultaron por dolor dental, ellos fueron evaluados clínica y radiográficamente con el fin de determinar la causa y la asociación con lesión periapical y periodontal y su posible proyección a territorios distintos de su origen. La prevalencia del DRD fue de 31,6 por ciento, mayor en mujeres (67,74 por ciento) aunque sin significancia estadística. El DRD se presentó en un 45,16 por ciento junto con lesión periapical y un 25,8 por ciento junto a lesión periodontal. No se encontró asociación entre la edad y la presencia de DRD. La alta prevalencia de DRD encontrada refuerza la necesidad de un diagnóstico etiológico del dolor orofacial.

Treatment of a lateral incisor anatomically complicated with palatogingival groove / 대한치과보존학회지

OBJECTIVES: Palatogingival groove is a developmental anomaly that starts near the cingulum of the tooth and runs down the cementoenamel junction in apical direction, terminating at various depths along the roots. While frequently associated with periodontal pockets and bone loss, pulpal necrosis of these teeth may precipitate a combined endodontic-periodontal lesion. This case presents a case of a lateral incisor anatomically complicated with palatogingival groove. METHODS: Two patients with lesion associated with the palatogingival groove were chosen for this report. Palatogingival grooves were treated with different restoration materials with endodontic treatment. CONCLUSIONS: Maxillary lateral incisor with a palatogingival groove may occur the periodontal disease with pulpal involvement. Elimination of groove may facilitate the periodontal re-attachment and prevent the recurrence.

Hopeless to hopeful: a clinical study on management of periodontal abscess with grade II furcation involvement - endodontic and periodontal interdisciplinary approach: case report / Da condenação à esperança: estudo clínico sobre o manejo do abscesso periodontal com envolvimento de furca grau II - abordagem interdisciplinar endodôntica e periodontal: relato de caso

OBJECTIVES: To present a case report of management of grade II furcation involvement associatedwith a periodontal abscess of mandibular right first molar utilizing an alloplastic bone graft. DISCUSSION:The case was diagnosed as periodontal abscess with grade-II furcation involvement and was primaryperiodontal lesion with secondary endodontic involvement. Treatment included scaling, root planing &curettage and root canal treatment of the involved tooth. Periodontal flap surgery was done with bonegraft placement in the furcation area. RESULTS: Patient was evaluated after onear. Radiographicexamination showed healing of furcation defect as well as resolution of periapical inflammation. Clinicalevaluation revealed resolution of furcation involvement as well as reduction of tooth mobility.

OBJETIVOS: Apresentar um caso de comprometimento grau II de furca, lesão primariamenteperiodontal com comprometimento endodôntico secundário, em primeiro molar inferior. Otratamento constituiu de alisamento radicular, curetagem e tratamento endodôntico do dentecomprometido. Cirurgia de retalho periodontal foi efetuada, com colocação de enxerto ósseo na área da furca. RESULTADOS: o paciente foi avaliado após um ano, sendo que a imagemradiográfica demonstrou cicatrização do defeito da furca, bem como resolução da inflamaçãoperiapical. A avaliação clínica demonstrou resolução da lesão da furca, bem como reduçãoda mobilidade dentária.