Need opinion on the treatment plan for the condition seen in the Radiagraph. 50 years old male, had history of trauma (irt 14) while trying to crush a chicken bone few years back. Pain in the gums since few days with mild inflammation seen clinically. 14 is grade 2 mobile. M/H - He is other wise normal. I have done deep scaling initially and prescribed ofloxacin and Ornidazole BD for 5 days with Metrogyl DG topical application. Now pain and symptoms have subsided after a week. Tooth mobility still present. Experts please guide me..., "Does it requires endodontic treatment also along with periodontal treatment " ? My consulting Periodontist said it is a case for "regenerative Osseous Surgery". ( I don't have clinical picture and please excuse me for that ).

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I am sorry ..I have an opinion which little differ from the opinion expressed by all the seniors here... Sir... If we go by literature then in thus case if there is no fracture then it is purely periodontal lesion with no involvement of root canal in anyways. .. And pulp doesn't get infected unless and untill main canal is involved. So if you go only with osseous surgery also using grafts and complete debridement then also the lesion will resolve and tooth will be saved without root canal treatment. The only thing is the patient may suffer from sensitivity but there will be definitely no root canal infection. If the sensitivity is severe then you can go for root canal treatment after wards. But as the pt is doctor and you want to be on very much safer side then intentional root canal treatment can be done....but IT IS NOT THE REQUIREMENT AND IT IS JUST FOR TO BE ON SAFER SIDE. Few things need to be kept in mind. .. That during debridement don't use ultrasonics scalers on the root surfers to prevent removal of healthy cementum which in turn will reduce sensitivity. mobility can be reduced by splinting till healing of the graft takes place because grafts fail in mobile tooth. IT'S NOT AN ENDO PERIO LESION IT IS PRIMARY PERIODONTIC LESION features of primary periodontics lesions are.. 1. tooth is vital 2. Radiographically and clincal the crown is intact ie no caries or restoration present. 3. bone loss radiography call 4. probing depth is wider at the pocket entrance compared to base of the pocket.

Chalo ladengae apan dono... As I read ... Perio-endo lesions are of 4 types. (classified due to their pathogenesis.) 1) Endodontic lesions- an inflammatory process in the periodontal tissues resulting from noxious agents present in the root canal system of the tooth. 2) Periodontal lesions- an inflammatory process in the pulpal tissues resulting from accumulation of dental plaque on the external root surfaces. 3) True-combined lesions- both an endodontic and periodontal lesion developing independently and progressing concurrently to meet along the root surface. 4) Iatrogenic lesions: usually endodontic lesions produced as a result of treatment modalities. Pathogenesis. Now, Categorization of periodontal lesions into two sub- categories: (Simon, Glick and Frank) A) Primary periodontal lesions with secondary endodontic involvement; periodontal disease causes a resultant pulpal necrosis as it progresses apically. B) Primary periodontal lesions, when there is a progression of periodontal lesion to involve the apex of a tooth while the "pulp is vital" (there may be some pulpal degenerative changes not seen in radiographics). Primary periodontal disease ----{with secondary endodontic involvement, (Looking at the thickening of the PL space) and true combined endodontic-periodontal diseases} require both endodontic and periodontal therapies.
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Vertical bone loss with combined endo perio lession ,u need to check the vitality of tooth also,will need both endo perio treatment ,regenerative surgical procedure will b needed also put tooth in infra occlusion

Tooth is vital. Thank you sir.
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Yes it is a case for regenerative Osseous surgery.

Thank you sir. Does it require endodontic treatment also Sir...
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Our objectives in dentistry are : - saving the tooth - preserving vitality of the pulp I suggest - do perio Tx without RCT - follow up and test vitality of the pulp - if the pulp becomes necrotic do RCT

Yes it does need an endo trtmnt...after perio surgery....raise the flap and currette well .... Bone graft with gtr membrane will help a lot

And splint it too ....reduce the occlusal level
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Endo perio Vitality of the pulp Rct Osseous surgery Bone graft Antibiotics Analgesics Antacids Mouthwash

Sir your periodontist said right...

Sir..this case( as described) seems that of a primary periodontal lesion...this bony defect can be surgically corrected. But before that correct the traumatic occlusion and then go for splinting. During the surgical procedure if the bony defect is seen very close to the apex then do the intentional rct.

1st it need regenerative osseous surgery with splinting....if mobility decrease after a period then go for RCT. if mobilility present after perio surgery then extraction needed...we cant save all teeth...

Bone grafting followed by endo(provided the tooth is not mobile)

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