Right from the start let me say that I am not a fan of doing endodontic retreatments on suspected perio-endo cases as I have found them (in my hands) to have a very mixed result. On this occasion, however, assessment of the existing root treatment would put it firmly in the category of “sub-optimal” and its impact on the outcome of the case likely to be negligible. (Although I am removing an existing root filling I tend to think of these as “open” cases where the microbiology of the canals is unlikely to differ greatly from an untreated, or de novo, case). The mesial root has clearly suffered extensive bone loss but there is very little way of knowing if the bone loss is primarily of periodontal or endodontic origin. By providing an adequate root filling we can hope to see improvement (and bone growth) for any of the “endodontic bone loss” but not from the periodontal loss.
The treatment was carried out as a one visit procedure combining oral hygiene and juxta-gingival scaling and pocket debridement but no deep cleaning to the full extent of the pocket as I did not want to damage any of the potentially healthy periodontal tissues at the base of the root, where the bone loss may be of endodontic origin.
The second radiograph is from 6 months later and shows initial apical bone growth around the mesial root. Clearly this is still a very damaged root but there has been pocket reduction from 9mm to 3mm and no bleeding on probing. (There has been an increase in recession to 3mm around the mesial root so I guess the actual attachment gain is only 3mm- sorry to any periodontists if I just spouted utter nonsense). It is fair to say that this is still a very damaged tooth but I feel that a definitive crown is indicated and, so long as oral hygiene is maintained we can have guarded optimism about a few more years use out of this tooth.
As ever, if you are experiencing pain or infection from a tooth and want to know if it can be saved please contact the surgery on 01580 752202 and we will be happy to help.