Page 25 - The Beauty and Sorrow in Endodontics-Chapter 3

# 24 periapical radiolucency with 3 roots (Fig 35B)

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A Dx: 24
Pulpal: Necrosis
Periapical: Chronic apical abscess

Etiology: Primary periodontal lesion with secondary endodontic involvement
P Discussed proposed treatment plan with the patient. Informed consent obtained to

proceed.

1) 24 Root canal treatment
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# 24 accessed and all three canals found under microscopic magnification

(Fig 35C). Root canal treatment completed following the standard protocol for
cleaning, shaping, and obturation (Fig 35D).

2) Follow-up

6-months– Persistent periapical radiolucency observed even though the soft
tissue has healed and mobility of 24 had reduced to grade 1 (Fig
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35E). Due to the special anatomy, it was suspected that calculus and
plaque may still be present in the furcation, and open flap

debridement was recommended.

** Note: The patient refused treatment as his chief complaint had been resolved and
he was comfortable with only conservative treatments (eg. scaling and root

planning). Since then, the patient has experienced episodes of periodontal abscess
that disappear after routine scaling. However, there was incomplete healing of the

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attachment apparatus surrounding 24 due to the patient’s failure to cooperate with
treatment recommendation.

Take Home Message: In cases of primary periodontal lesion with endodontic

involvement, without the patient’s full cooperation to all necessary periodontal and
endodontic treatments, it is impossible to achieve complete healing around the

affected tooth.

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