Perio or Endo?
This case was referred by a local periodontist for Endodontic consideration of this mandibular right second molar. The patient presented with gross labial gingival swelling along the gingival Crest and what appeared to be a periodontal Abscess.
A large MO amalgam restoration was placed in the tooth that appeared to be approximating the pulp. The Periodontist was not sure whether the furcal breakdown was of Endodontic or pure Periodontal origin. The patient exhibited some mesio-angular bone loss in this tooth bone loss but no other evidence of bone loss associated with chronic Periodontal disease. The findings in this tooth could be consistent with furcation involvement of this tooth due to periodontal and not endodontic reasons.
Radiographic examination showed a deep amalgam restoration and a small radiolucent finding in the the furcation. The root apices showed no such radiolucencies. The Crown/Root ratio was noted to be fairly short and the furcation level appeared to be close to that of the bone crest. There certainly was gross evidence of periodontal disease. The sensed that the tooth was probably NOT a good candidate for regenerative or other Perio surgery.
Localized gingival swelling is apparent at the gingival margin. Probing of the furcation was Class 2 positive and the area was quite tender to palpation along the gingival margin. The tooth was slightly percussion and chewing sensitive.
Pulp tests were performed, and the pulp was normally responsive to cold. This was inconsistent with periapical breakdown of Endodontic origin. A diagnosis of acute Periodontal Abscess was made. I explained to the Periodontist that the tooth was not Endodontically involved and that any periodical radiolucent findings that were associated with this tooth were not Endo related . The diagram I used is above and I find such notations very helpful when discussing cases with patients. It is also a very good way to record your discussions with the patient when sending reports to referrals and to properly document the case. I explained that Endodontic treatment of this tooth would not be of benefit to the patient. I felt that the periodontal prognosis for this tooth was hopeless and that the tooth should be extracted. The patient was returned to the referring Periodontist for discussions regarding extraction and prosthetic replacement.
Pulp tests were performed, and the pulp was normally responsive to cold. This was inconsistent with periapical breakdown of Endodontic origin. A diagnosis of acute Periodontal Abscess was made. I explained to the Periodontist that the tooth was not Endodontically involved and that any periodical radiolucent findings that were associated with this tooth were not Endo related . The diagram I used is above and I find such notations very helpful when discussing cases with patients. It is also a very good way to record your discussions with the patient when sending reports to referrals and to properly document the case. I explained that Endodontic treatment of this tooth would not be of benefit to the patient. I felt that the periodontal prognosis for this tooth was hopeless and that the tooth should be extracted. The patient was returned to the referring Periodontist for discussions regarding extraction and prosthetic replacement.