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The aim of the present clinical report is to introduce a novel surgical procedure, the 'Apical Tooth Replantation with Surgical Intrusion Technique' (ATR-SIT) for managing teeth with hopeless prognosis compromised with a severe endodontal-periodontal lesion, pathologic tooth migration, and gingival recession. Two cases are presented managing teeth diagnosed with a hopeless prognosis. ATR-SIT involves tooth extraction, extra-oral root debridement, root surface conditioning, apicectomy, retrograde filling and the application of enamel matrix derivatives prior to reimplantation. Following reimplantation, the teeth are covered with a combination of autogenous bone chips and bone substitute materials, covered with resorbable membranes. Following ATR-SIT, the patients received either orthodontic treatment or tooth-supported fixed dental prostheses. The described ATR-SIT effectively improved the initially hopeless prognosis of the teeth and maintained periodontal health over time, evidenced by favourable clinical and radiographic outcomes. ATR-SIT might be a potential alternative to tooth extraction of hopeless teeth in patients with stage IV periodontitis.

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(1) Background: Severely compromised teeth affected by endo-periodontal lesions are often assigned a "hopeless" prognosis, however, there is only limited evidence available. (2) Methods: In a retrospective study, we evaluated the long-term effectiveness of combined endodontic and regenerative periodontal therapy in teeth with advanced endo-periodontal lesions: 35 patients (age 47-83 years) with a total of 39 teeth diagnosed with grade 3 endo-periodontal lesions were treated by endodontists using an operating microscope followed by regenerative periodontal surgery. (3) Results: Changes in radiographic bone levels (rBl) and probing pocket depths (PPDs) were evaluated after 1 year (T1) and up to 7 years postoperatively (Tfinal). Mean rBL gain was significant with 4.87 ± 3.47 mm after 1 year (T1) and stable results with a mean rBL gain of 4.70 ± 3.37 mm at Tfinal. Mean PPD was significantly reduced from 9.74 ± 2.05 mm at baseline to 5.04 ± 1.61 mm at T1 and to 4.87 ± 2.32 mm at Tfinal. Tooth loss amounted to 10.3% (n = 4) and was due to root fracture. (4) Conclusion: The results suggest that the combined endodontic and regenerative periodontal therapy of endo-periodontal lesions of "hopeless" teeth can lead to favorable long-term results with tooth retention for up to 7 years.

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@#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.

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This case report describes the diagnosis, multidisciplinary treatment, and long-term follow-up of a severely compromised tooth in a patient who was referred for assessing a gingival recession. Clinical evaluation of the left maxillary canine showed 12 mm of mid-buccal gingival recession, probing depth of 14 mm on the mesial-buccal aspect, and grade III mobility. A periapical radiograph revealed extensive periapical and lateral radiolucency. The first step of the treatment was to carry out oral hygiene instructions and full-mouth debridement. After that, endodontic treatment was performed immediately. Periodontal reevaluation four months after endodontic therapy revealed that probing depths of all sites were within 3 mm and periapical radiograph showed a slight decrease in periapical and lateral radiolucency. It was subsequently decided to perform root coverage with a laterally positioned flap and subepithelial connective tissue graft. Six months after surgery, the root surface showed 1 mm recession, representing root coverage of 91.7% and a gain of attachment of 13 mm. The patient was enrolled in a 6-month supportive periodontal therapy. Treatment outcomes were evaluated over 18 years, with successful radiographic and clinical results throughout the follow-up period. The successful management of endo-periodontal lesions requires an accurate diagnosis, which is imperative to provide proper therapy in the correct treatment sequence.

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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)

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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)

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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).

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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).

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A new periodontitis classification scheme has been adopted, in which forms of the disease previously recognized as "chronic" or "aggressive" are now grouped under a single category ("periodontitis") and are further characterized based on a multi-dimensional staging and grading system. Staging is largely dependent upon the severity of disease at presentation as well as on the complexity of disease management, while grading provides supplemental information about biological features of the disease including a history-based analysis of the rate of periodontitis progression; assessment of the risk for further progression; analysis of possible poor outcomes of treatment; and assessment of the risk that the disease or its treatment may negatively affect the general health of the patient. Necrotizing periodontal diseases, whose characteristic clinical phenotype includes typical features (papilla necrosis, bleeding, and pain) and are associated with host immune response impairments, remain a distinct periodontitis category. Endodontic-periodontal lesions, defined by a pathological communication between the pulpal and periodontal tissues at a given tooth, occur in either an acute or a chronic form, and are classified according to signs and symptoms that have direct impact on their prognosis and treatment. Periodontal abscesses are defined as acute lesions characterized by localized accumulation of pus within the gingival wall of the periodontal pocket/sulcus, rapid tissue destruction and are associated with risk for systemic dissemination.

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A new periodontitis classification scheme has been adopted, in which forms of the disease previously recognized as "chronic" or "aggressive" are now grouped under a single category ("periodontitis") and are further characterized based on a multi-dimensional staging and grading system. Staging is largely dependent upon the severity of disease at presentation as well as on the complexity of disease management, while grading provides supplemental information about biological features of the disease including a history-based analysis of the rate of periodontitis progression; assessment of the risk for further progression; analysis of possible poor outcomes of treatment; and assessment of the risk that the disease or its treatment may negatively affect the general health of the patient. Necrotizing periodontal diseases, whose characteristic clinical phenotype includes typical features (papilla necrosis, bleeding, and pain) and are associated with host immune response impairments, remain a distinct periodontitis category. Endodontic-periodontal lesions, defined by a pathological communication between the pulpal and periodontal tissues at a given tooth, occur in either an acute or a chronic form, and are classified according to signs and symptoms that have direct impact on their prognosis and treatment. Periodontal abscesses are defined as acute lesions characterized by localized accumulation of pus within the gingival wall of the periodontal pocket/sulcus, rapid tissue destruction and are associated with risk for systemic dissemination.

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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)

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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.

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Damage of pulp tissue usually begins in the coronal pulp. Its mistreatment or its lack of on time detection determines the progressive inclusion of the whole endodontic space in its evolution, opening the way of its expansion in the surrounding tissues of the tooth, and on the marginal apical tissue. Aim. The goal of this study was to highlight that the primary endodontic lesions with secondary periodontal implication healed and bone repair was obtained due to a proper disinfection and an adequate sealing of the endodontic system. In primary endodontic lesion with secondary periodontal involvement, endodontic treatment is required in the first stage followed by specific periodontal treatment. The prognosis is good if an appropriate endodontic approach is chosen, depending on the stage of the periodontal disease and the treatment response. The identification of the etiological factors is the most important to establish the appropriate treatment. In all clinical cases selected in this article, the healing tendency was noticed after an adequate disinfection and sealing of the endodontic system.

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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.

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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.

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Endo-perio lesions might be interdependent because of the vascular and anatomic connections between the pulp and the periodontium. The aim of this study is to emphasise that primary endodontic lesion heals after a proper instrumentation, disinfection and sealing of the endodontic space. The primary endodontic lesion with a secondary periodontal involvement first requires an endodontic therapy and, in the second stage, a periodontal therapy. The prognosis is good, with an adequate root canal treatment; it depends on the severity of the periodontal disease, appropriate healing time and the response to the treatment. A correct diagnosis is sometimes difficult; an accurate identification of the etiologic factors is important for an adequate treatment. Primary perio-endo lesion may heal after a proper disinfection and sealing of the endodontic system, the one-year follow-up radiograph showing bonny repair. Invasive periodontal procedures should be avoided at that moment. The microorganisms and by-products from the infected root canal may cross accessory and furcal canals and determine sinus tract and loss of attachment. In both clinical cases presented in this article, successful healing was obtained after a proper disinfection and sealing of the endodontic system.

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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.

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