Treatment of an Endo-Perio Lesion with Ozone Gas in a Patient with Aggressive Periodontitis: A Clinical Case Report and Literature Review

Abstract

The pulp and periodontium have obvious relationships that have been described in many studies. Pulp infections may affect periodontal tissues and vice versa. Teeth with endo-perio lesions have a worse prognosis than isolated endodontic or periodontal lesions. Elimination of endodontic and periodontal infections is essential for successful treatment, so co-operation between endodontists and periodontists is necessary. In this clinical case, a 44-year-old male presented with primary periodontal disease with secondary endodontic involvement in his lower right canine because of aggressive periodontitis. There was 10 mm of clinical attachment loss and 8 mm periodontal pocket mesial from the tooth and bone radiolucency periapical and lateral from the root. Periodontal therapy was followed by endodontic treatment. Periodontal therapy included root scaling and planing, treatment of the periodontal pocket with ozone gas, systemic antibiotics, oral hygiene instructions, and chlorhexidine rinsing. Endodontic therapy included root canal instrumentation with rotary endodontic files, irrigation, root canal treatment with ozone gas, and obturation with lateral compaction. Radiographs at a 6-month follow-up appointment showed complete healing of the periapical lesion and alveolar bone lateral to the root. Using an interdisciplinary approach to treat endo-perio lesions provides favorable clinical outcomes. Ozone therapy is beneficial for the successful treatment of endo-perio lesions with narrow periodontal pockets in patients with aggressive periodontitis and poor prognosis.

Keywords: endo-perio lesion; ozone gas; ozone therapy.

Figure 1

(A) Intraoral view of the upper right quadrant at baseline; calculus and gum bleeding is visible. (B) Intraoral view of the frontal lower teeth at baseline; small amounts of calculus and pus discharge are visible.

Figure 2

Panoramic radiograph at baseline.

Figure 3

(A) Upper right quadrant after antibiotic therapy. (B) Frontal lower teeth after antibiotic therapy.

Figure 4

Intraoral view of the frontal lower teeth 14 days after SRP and splinting.

Figure 5

Intraoral view 6 months after SRP.

Figure 6

Panoramic radiograph 6 months after SRP: tooth #43 showed an extensive periapical lesion with well-defined borders and bone loss extruding onto the root’s mesial surface.

Figure 7

“Walking” probing of the periodontal pocket using a Naber periodontal probe. Distal buccal point (A), middle buccal point (B), mesial buccal point (C), all measurements are 2 mm probing depth. (D) Narrow and deep 8 mm periodontal pocket on the mesial tooth surface.

Figure 8

(A) No bleeding was observed immediately after endodontic access opening. (B) Instrumentation of the root canal using an iRace rotary endodontic instrument. (C) Passive ultrasound irrigation with an ultrasound tip. (D) Treating the root canal with ozone gas.

Figure 9

(A) Working length confirmation. (B) Immediately after obturation. (C) Six-month follow-up showing complete healing of the bone defect in the periapical area and interdental septum.

Figure 10

Prozone ozone generator.