Patient Complaint:
A patient visited our dental clinic with the complaint of persistent pain in the lower left back tooth region. The discomfort had been ongoing, especially while chewing, and was causing considerable inconvenience in daily life.
Clinical Examination:
On intraoral examination, tooth 36 (lower left first molar) showed signs of Grade 1 mobility, indicating slight movement. The gums appeared inflamed around the area, and the patient reported tenderness on percussion.
Radiographic Findings:
A radiograph was advised to assess the underlying condition. The X-ray revealed a combined perio-endo lesion in tooth 36 a condition where both the periodontal (gum and bone) and pulpal (nerve) tissues are affected.
Diagnosis:
Perio-Endo Lesion irt 36 This dual origin infection requires a strategic approach. Since the pulp was non-vital and the tooth was restorable, a Root Canal Treatment (RCT) was planned. However, due to the periodontal involvement, a staged treatment protocol was necessary.
Treatment Protocol
1. Initial Phase Root Canal & Infection Control:
- Access opening and biomechanical preparation (BMP) of the canals were done.
- Intracanal Medicament (ICM) was placed in the canals to eliminate infection and promote healing.
- The patient was recalled after 2 weeks for review.
2. Periodontal Therapy:
- In the meantime, scaling and root planing (deep cleaning) were performed to reduce gum inflammation and bacterial load.
- Oral hygiene instructions were reinforced to support tissue healing.
3. Monitoring & Evaluation:
- At the 2-week follow-up, the patient reported significant pain relief.
- Mobility had reduced, and the surrounding gingival tissue appeared healthier.
4. Obturation & Final Restoration:
- With improved periodontal stability, root canal obturation was completed.
- The tooth was then restored with a full coverage crown, providing strength and long-term protection.
Outcome
The patient experienced complete relief from pain and regained confidence while chewing. Mobility was no longer present, and the crown helped restore full function and aesthetics.
Takeaway
Perio-endo lesions require a coordinated approach involving both endodontic and periodontal treatment. Early diagnosis and timely intervention can help save natural teeth that might otherwise be lost.
If you're experiencing similar symptoms pain, gum swelling, or tooth mobility don't delay. Consult your dentist early for a thorough evaluation and treatment plan.