Pace Riccardo, Di Gianfilippo Riccardo, Franceschi Debora, Pini Prato GiovanPaolo
Department of Endodontics, The University of Florence, Florence, Italy.
Pacific Academy of Periodontal and Implant Research (PAPIR), Bellevue, Washington, USA.
Clin Adv Periodontics. 2024 Jun 10. doi: 10.1002/cap.10297.
This study presents the diagnois, management, and tissue response to an acute periodontal lesion with deep pocketing affecting a maxillary central incisor in a young patient devoid of caries or a history of periodontitis.
Clinical and radiographic examinations facilitated the diagnosis of the pathology as an endoperiodontal lesion (EPL) with root damage, exhibiting supracrestal invasive root resorption. Orthograde endodontic therapy was employed to decontaminate and seal the endodontic space. The resorptive site was treated through the endodontic access, debrided, and sealed. No periodontal therapy (surgical or nonsurgical) was performed. No mechanical instrumentation was performed within the pocketed root surface.
At 6-month and 1-year follow-ups after endodontic therapy the periodontium displayed a physiologically healthy condition without pus or inflammation, exhibiting a circumferential probing depth of 2 mm, and absence of tooth mobility. These favorable outcomes persisted throughout a 4-year follow-up period.
The spontaneous healing of pocketing and abscess occurred without mechanical root instrumentation following endodontic therapy and treatment of external invasive root resorption in an EPL.
Accurate diagnosis and identification of relevant etiologic factors are pivotal for effectively managing endodontic-periodontal lesions. Once a diagnosis is established, the therapy focuses on eliminating the primary cause, followed by a subsequent diagnostic phase after healing. The definitive understanding of the diagnosis and etiology of endodontic-periodontal lesions often becomes clear in retrospect, based on the outcomes of the therapy. When probing acute periodontal lesions, deep probing depths may occur without permanent loss of periodontal attachment. If the acute lesion was not induced by a periodontal cause and if no periodontal etiology arises secondarily, resolving the primary cause of the endoperiodontal lesion can lead to the spontaneous resolution of the pocketing. This results in spontaneous healing of periodontium without the need for intentional periodontal therapy. A clinical dilemma arises when considering periodontal treatment during the acute inflammatory phase of endo-periodontal pathology. It is advisable to refrain from mechanical root instrumentation particularly if a clear periodontal cause is not apparent, to prevent from iatrogenic damage to periodontal fibers and the potential risk of gingival recessions. However, this does not imply avoiding periodontal therapy entirely for every case. Rather, it is recommended to delay the decision on root instrumentation until a new diagnostic phase is conducted following the healing of the endodontic etiology.
本研究介绍了一名年轻患者上颌中切牙出现伴有深牙周袋的急性牙周病变的诊断、处理及组织反应，该患者无龋齿或牙周炎病史。
临床和影像学检查有助于将病变诊断为伴有牙根损害的牙髓牙周联合病变（EPL），表现为龈上侵袭性牙根吸收。采用顺行性根管治疗对根管系统进行消毒和封闭。通过根管入口对吸收部位进行处理、清创和封闭。未进行牙周治疗（手术或非手术）。未对有牙周袋的牙根表面进行机械清创。
根管治疗后6个月和1年的随访显示，牙周组织处于生理健康状态，无脓液或炎症，探诊深度为2mm，牙齿无松动。这些良好结果在4年的随访期内持续存在。
牙髓牙周联合病变在根管治疗及外部侵袭性牙根吸收治疗后，未进行机械性牙根清创，牙周袋和脓肿自发愈合。
准确诊断和识别相关病因对于有效处理牙髓牙周病变至关重要。一旦确诊，治疗重点在于消除主要病因，随后在愈合后进入后续诊断阶段。基于治疗结果，牙髓牙周病变的诊断和病因的确切理解往往在回顾时才变得清晰。探查急性牙周病变时，可能出现较深的探诊深度，但牙周附着无永久性丧失。如果急性病变不是由牙周原因引起，且未继发牙周病因，解决牙髓牙周联合病变的主要病因可导致牙周袋自发消退。这会使牙周组织自发愈合，无需进行刻意的牙周治疗。在牙髓牙周病变的急性炎症期考虑牙周治疗时会出现临床困境。尤其在明确的牙周病因不明显时，建议避免进行机械性牙根清创，以防止医源性损伤牙周纤维和牙龈退缩的潜在风险。然而，这并不意味着对每个病例都完全避免牙周治疗。相反，建议在牙髓病因愈合后进行新的诊断阶段之前，推迟牙根清创的决定。
