ABSTRACT
The actual relationship between periodontal and pulpal disease was first described by Simring & Goldberg in 1964. The periodontium communicates with the dental pulp through a variety of routes, including dentinal tubules, the apical foramen, and lateral and accessory canals. These are the passageways by which pathological agents travel between the pulp and periodontium, resulting in the endo-perio lesions. A 53-year-old male patient appeared with a chief complaint of pain on biting and tooth mobility in the right maxillary molar tooth. The patient had no prior dental treatment and was a systemically healthy patient. A clinical intraoral examination of tooth 16 revealed a non-carious tooth, supragingival plaque and stains, and subgingival calculus. The tooth was nonresponsive to vitality tests and tested positive for the percussion test. Periodontal examination showed deep periodontal pockets on the palatal region (mesially–10 mm, mid-palatally–5.5 mm, distally–8.5 mm) and grade-1 mobility. A radiographic examination revealed a large periapical lesion with periradicular bone loss of palatal root. The tooth was relieved from occlusion. Endodontic therapy was completed in three visits under rubber dam isolation, in a span of 2 weeks with inter-appointment calcium hydroxide intracanal medicaments. The canal was obturated using bioceramic sealer and access restoration was done with packable resin composite at the fourth appointment. No periodontal intervention was carried out. This case report describes the successful management of a right maxillary first molar with a primary periodontal lesion with secondary endodontic involvement managed by phase-I of periodontal therapy and non-surgical endodontic treatment. In spite of the anticipated poor prognosis, the tooth lesion showed a decrease in the size of the periodontal lesion and an absence of tooth mobility.
