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Case Reports
. 2025 Jun 10;17(6):e85715.
doi: 10.7759/cureus.85715. eCollection 2025 Jun.

A Multidisciplinary Approach in the Management of a Grade 3 Endo-Periodontal Lesion

Oulghazi Ichraq  1 , Mariam Mounsif  2 , Maria Fennich  3 , Amal El Yamani  1
Affiliations
Case Reports

A Multidisciplinary Approach in the Management of a Grade 3 Endo-Periodontal Lesion

Oulghazi Ichraq et al. Cureus. .

Abstract

Endodontic-periodontal lesions involve a pathological connection between the pulpal and periodontal tissues, often complicating both diagnosis and treatment. Accurate identification and classification are essential to determine an appropriate therapeutic approach. This case report describes the multidisciplinary management of a grade 3 endo-periodontal lesion without root damage. A 43-year-old female presented with pain and swelling in the left mandibular first molar. Clinical and radiographic findings indicated a failed root canal treatment, deep periodontal pockets, and furcation involvement. After emergency drainage of a periodontal abscess, endodontic retreatment was initiated with sodium hypochlorite irrigation and calcium hydroxide medication, followed by canal obturation and coronal restoration. Non-surgical periodontal therapy was also performed. Over a three-year follow-up, clinical and radiographic evaluations confirmed resolution of symptoms and periodontal stability. This case highlights the importance of a sequential, combined approach and emphasizes the need for a proper coronal seal to ensure long-term success in managing complex endo-periodontal lesions.

Keywords: endo-periodontal lesion; grade 3 periodontal lesion; multidisciplinary approach; periodontal therapy; root canal retreatment.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. (a) Intraoral view revealing the presence of a periodontal pocket and gingival swelling. (b) Preoperative periapical radiograph showing periapical and interradicular radiolucency. (c) Intraoral view after scaling and drainage of the periodontal abscess.
Figure 2
Figure 2. Initial periodontal charting.
Figure 3
Figure 3. (a) Periapical radiograph with a file in place following canal de-obturation. (b) Endodontic drainage using a file, showing purulent exudate.
Figure 4
Figure 4. (a) Periapical radiograph with gutta-percha cones. (b) Periapical radiograph after root canal obturation.
Figure 5
Figure 5. Intraoral view showing coronal restoration with composite resin.
Figure 6
Figure 6. Periodontal charting at three-month postoperative follow‑up.
Figure 7
Figure 7. Periapical radiograph demonstrating regression and bone regeneration in the interradicular and periapical regions at one-year follow-up.
Figure 8
Figure 8. (a) Endobuccal view of the prosthetic restoration. (b) Periapical radiograph showing the prosthetic rehabilitation at three-year follow-up.
See this image and copyright information in PMC

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