Endo-Perio Lesion is a lesion having both endodontic and periodontal origin. The case becomes more confusing when the patient only comes with the history of pain along with tooth discoloration. At that time, taking an IOPA is the first thing that should be done.

The prime area where a pulpal tissue gets connected with the periodontium is apical foramen. Other than apical foramen and accessory canals, dental tubules is another area from where infection can spread both ways leading to endo-perio lesion.

According to Simon et al, endodontic periodontal lesions can be classified into following subtypes:

 

 

Diagnosis of Endodontic Periodontal Lesion

Mucosal Examination: The first thing if to be done is to visually examine the alveolar mucosa and gingiva for any inflammation, ulceration or sinus tract. If there is presence of sinus tract, then it is mostly associated with necrotic pulp.

Digital Pressure: A pressure is exerted on the said area using a thumb. If there is endo-perio lesion, then it will cause pain localized to that area.

Percussion Test: Positive response to this test is a sign of inflammation of periodontal ligament though it can’t be said that whether it is of pulpal or periodontal origin.

IOPA View: Radiograph is compulsory to look for any radioluscency in the apical tooth region.

Fistulous Sinus Tract: It is a common condition in case of endo-perio lesions. Fistula tracking is done by putting a gutta percha or softened silver cones into the sinus tract until resistance is felt. After that a radiograph is taken revealing the course of sinus tract and the starting point of inflammation.

 

A Live Case Study of Endo-Perio Lesion

A female patient came with the complaint of pus discharge from right maxillary lateral incisor. Also her tooth was discolored.

She was clinical evaluated by the dentist and three things were reported:

  1. Distal probing depth of 12mm

  2. Grade I mobility

  3. Sinus opening w.r.t 12 (right maxillary lateral incisor)

 

After clinical examination, IOPA was taken to get the exact cause of pus discharge and pain. Radiograph showed radioluscency at the apex of the tooth.

After studying the complaint, the result of tests performed and radiographs, the case was diagnosed to be of endo-perio lesion.

 

 

Treatment of the Endo-Perio Lesion

To start with, RCT was re-done in the affected tooth. The patient was examined for 2 days to look for any improvement. After 2 days, periodontal surgery was planned.

Upon opening the area, 3 wall osseous destruction was seen on the distal side of the tooth. Curettage was done and after that the Alloplastic bone graft along with Guided Tissue Regeneration was filled into the defect.

Finally after repositioning the flap, suturing was done.

During follow ups, significant improvement was seen and after a year of surgery there was no sign of osseous defect.

 

 

Post Operative Instructions

Cold Pack: Immediately after the surgery, there is intense swelling. To overcome that it is recommended to place an ice bag over the surgical site 20 minutes on and 20 minutes off for at least a day.

Don’t Skip Meals: It is recommended to take liquid diet like soup, juices for initial days and gradually you can shift to solid food but take care not to skip meals.

Don’t Smoke: Smoking after grafting increases the chances of failure by 15-20 percent so it is advised not to smoke after the surgery. Also avoid alcohol.

Oral Hygiene: Maintain proper oral hygiene post surgery. 24 hours after surgery, rinse at least twice daily.  Rinsing with warm saline water accelerates the healing process.

While brushing, use an extra soft bristles tooth brush. Avoid using electric tooth brushes.

Don’t touch or poke the surgical site using a probe or with tongue.

Don’t sneeze, spit or cough forcefully.

 

Initial couple of days post surgery will be problematic for the patients due to extra precautions they need to take but from the third day, things gradually begins to settle down. Also go for regular follow ups as advised by your dentist till the surgical site is completely healed.

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