Alquthami Hind, Almalik Abdulaziz M, Alzahrani Faisal F, Badawi Lana
Department of Dentistry, Division of Endodontics, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh 11159, Saudi Arabia.
Department of Dentistry, Division of Periodontics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
Case Rep Dent. 2018 May 29;2018:7084245. doi: 10.1155/2018/7084245. eCollection 2018.
Endodontic-periodontal diseases often present great challenges to the clinician in their diagnosis, management, and prognosis. Understanding the disease process through cause-and-effect relationships between the pulp and supporting periodontal tissues with the aid of rational classifications leads to successful treatment outcomes. In this report, we present several treatment modalities in patients with different endodontic-periodontal lesions. A modification to the new endodontic-periodontic classification, Al-Fouzan's classification, was also added. The first case was classified as retrograde periodontal disease (i.e., primary endodontic lesion with drainage through the periodontal ligament). The second case was diagnosed as an iatrogenic periodontal lesion caused by root perforation. The third case was diagnosed as an iatrogenic periodontal lesion caused by tooth trauma due to orthodontic treatment. The first two cases were managed with a nonsurgical approach, whereas the third case was managed with nonsurgical and surgical approaches. All patients showed complete healing of soft and hard tissue lesions. A thorough understanding of the disease history and the patient's signs and symptoms, complete examination with full investigation, and the use of a systematic step-by-step approach in the management of such challenging endodontic-periodontal lesions with regular recall visits were very useful and successful.
牙髓牙周疾病在诊断、治疗和预后方面常常给临床医生带来巨大挑战。借助合理的分类，通过牙髓与支持性牙周组织之间的因果关系来理解疾病过程，可实现成功的治疗效果。在本报告中，我们介绍了不同牙髓牙周病变患者的几种治疗方式。同时还对新的牙髓牙周分类——Al-Fouzan分类进行了修订。第一例被归类为逆行性牙周疾病（即原发性牙髓病变通过牙周膜引流）。第二例被诊断为因牙根穿孔导致的医源性牙周病变。第三例被诊断为正畸治疗引起的牙齿创伤导致的医源性牙周病变。前两例采用非手术方法治疗，而第三例采用非手术和手术方法治疗。所有患者的软硬组织病变均完全愈合。深入了解疾病史以及患者的体征和症状，进行全面检查和充分调查，并在管理此类具有挑战性的牙髓牙周病变时采用系统的逐步方法，定期进行复查，非常有用且成功。
