Role of Periodontist
Role of Periodontist
Role of Periodontist
Abstract
Introduction: The interdisciplinary approach has been a trend for a comprehensive dental treatment. Within modern dentistry, Peri-
odontics, Endododntics and Prosthodontics share an intimate and inseparable relationship in multiple aspects, including treatment
plan, procedures execution, outcome achievement and maintenance. To ensure an overall successful treatment since these specialties
share a common goal: to create pleasing esthetic with a harmonious stomatognathic system.
Objective: This case series demonstrates the use of periodontal intervention in endodontically complicated cases with questionable
prognosis which were finally rehabilitated with multidisciplinary approach. Surgical Periodontics is good option for salvaging such
complicated cases which can be brought back to function by final prosthetic management.
Methodology: 02 clinical cases molars were treated with periodontal surgery involving, hemi section and followed by PFM crowns.
Both cases were followed up for a period of 1 year by clinically and radio graphically.
Result: 1 year of follow up showed favorable and predictable result. Both patients presented adequate chewing efficiency with well-
maintained oral hygiene around the prosthesis. None of the patients were shown any further deterioration one year post operatively.
The patients are comfortably using the teeth for proper mastication without any further clinical discomforts.
Conclusion: In this case presentation, the scope of multi-disciplinary approach has been outlined to aid the dental team in salvaging
endodontically complicated cases. Proper management by Periodontist, Endodontist and Prosthodontist as a team should be con-
sider before suggesting extraction for such cases.
Keywords: Periodontist; Endododntics; Prosthodontics; Hemisection
Introduction The loss of functional teeth can result in several undesirable se-
quelae. The loss of posterior teeth can result in several undesirable
The combined utilization of the expertise and skills in various
sequelae; hence a guiding principle should be followed to try and
dental disciplines is called interdisciplinary therapy. The prefix “in-
maintain what is present. Whether there is a functional need for
ter” signifies the working between the disciplines, instead of disci-
the tooth or the tooth is restorable after the lesion has been treated
plines acting as separate entities. The relationship between peri-
or the patient is suitable for lengthy, costly and invasive treatments
odontal health and restoration of teeth is intimate and inseparable
are factors that should be taken into consideration. If any of these
which had been deliberated in the past extensively. For restoration
factors are deemed negative, extraction is the treatment of choice.
to survive long term, the periodontium must be healthy so that the
teeth are maintained for a long time. The real art of dentistry is to
This case report presents two different types of modalities
co-ordinate and interface these perspectives and provide the best
with multidisciplinary approach. Both cases were reported to the
quality of care to the patient [1].
OPD with endodontically failure which were treated with re root
As on today, endodontic-periodontal lesions present challenges canal therapy, hemisection followed by post and core supported
to the clinician in terms of diagnosis and prognosis. A sound peri- PFM prosthesis. 09 months follow up of both cases after treatment
odontium provides a firm foundation for an esthetic and functional showed very good prognosis with good chewing efficiency. Root
prosthesis. Perforations in the furcation of molars or inter radicu- fracture is the main cause of failure after hemisection, so proper
lar are often cause inflammation and subsequent alveolar bone loss prosthetic and periodontal considerations are required to balance
and these areas are difficult to manage. Accurate diagnosis can be the occlusal forces on the remaining root [3]. All these cases were
achieved by careful history taking, examination and the use of spe- rehabilitated with best prosthetic principles to avoid further com-
cial tests [2]. Timely diagnosis and management can salvage such plications.
complicated cases.
Citation: Prasanth T. “Hopeless to Hopeful-Role of Periodontist in Multidisciplinary Approach of Endodontically Failing Cases”. Acta Scientific Dental
Sciences 2.7 (2018): 53-57.
Hopeless to Hopeful-Role of Periodontist in Multidisciplinary Approach of Endodontically Failing Cases
54
The crown was sectioned and splitted carefully at the level of fur-
cation and the distal half was removed with the help of periotome
and elevators (Figure 3). A finishing bur was used to smooth on the
Figure 6: Post-surgical IOPA.
Citation: Prasanth T. “Hopeless to Hopeful-Role of Periodontist in Multidisciplinary Approach of Endodontically Failing Cases”. Acta Scientific Dental
Sciences 2.7 (2018): 53-57.
Hopeless to Hopeful-Role of Periodontist in Multidisciplinary Approach of Endodontically Failing Cases
55
After 3 months of surgery, patient was reassessed for prosthetic inter proximal area of 46 and 47 seen in the RVG image (Figure
rehabilitation. The healing was adequate without any post-opera- 10).
tive discomfort. The sinus track was completely disappeared. The
prosthetic rehabilitation was planned for the patient PFM crown.
The crown was given in the subsequent sittings (Figure 7). 9 months
follow up showed favorable result with adequate chewing efficiency
(Figure 8).
Citation: Prasanth T. “Hopeless to Hopeful-Role of Periodontist in Multidisciplinary Approach of Endodontically Failing Cases”. Acta Scientific Dental
Sciences 2.7 (2018): 53-57.
Hopeless to Hopeful-Role of Periodontist in Multidisciplinary Approach of Endodontically Failing Cases
56
Figure 12: 3 months post op- fibre post in situ. There are various important factors which can determined the
success of these kinds of procedures. Study by Buhler [6]. sug-
gested that accessibility of root furcation for easy separation, ad-
equate bone support for the remaining root, the smaller size of the
occlusal tables, under contouring of the embrasure spaces and en-
suring that the crown margin encompasses the furcation are the
factors which determine the success rate of Hemisection therapy.
Citation: Prasanth T. “Hopeless to Hopeful-Role of Periodontist in Multidisciplinary Approach of Endodontically Failing Cases”. Acta Scientific Dental
Sciences 2.7 (2018): 53-57.
Hopeless to Hopeful-Role of Periodontist in Multidisciplinary Approach of Endodontically Failing Cases
57
ologic tooth mobility of the remaining root, which is thus a more 7. Weine FS. “Endodontic Therapy”. 5 Edition.
th
Conclusion
The result of the present case report suggests that the success-
ful multidisciplinary management of endodontically complicated
teeth by an Endodontist, prosthodontist and Periodontist resulted
in a significant amount improvement clinical attachment levels
and healthy gingival. The use of these kind of therapy to retain a
compromised tooth, offers a predictable treatment option with a
prognosis comparable to any tooth with an endodontic treatment.
Hemisection is a relatively simple, inexpensive treatment with a
good chance of success. Proper case selection including load bear-
ing capacity of the rest of the root enhances the therapeutic success.
It should always be considered as an option before molar extrac-
tion. Proper diagnosis, case selection and treatment planning are
the guiding factors for the success of this treatment. Both cases with
12 months of follow up, patients presented adequate chewing ef-
ficiency with well-maintained oral hygiene around the prosthesis.
It is proven that when retention of a part of a tooth seems to extend
the life of prosthesis, the patient certainly deserves the option of
these kinds of treatment rather than extraction.
Bibliography
Citation: Prasanth T. “Hopeless to Hopeful-Role of Periodontist in Multidisciplinary Approach of Endodontically Failing Cases”. Acta Scientific Dental
Sciences 2.7 (2018): 53-57.