An interdisciplinary approach for management of an Endo-Perio Lesion in a necrotic Mandibular Second Molar with a type I Furcation Canal: A Case Report with a 6-month Follow-up

Introduction: Communications between endodontic and periodontal tissue may occur through apical foramen and lateral canals allowing bi-directional spread. Furcation canals are considered-lateral canals found at the floor of the pulp chamber. Infected pulps may induce tissue destruction-in adjoining periodontal tissues, apically and in the bifurcation area. Proper root canal shaping, disinfection as well as Furcation canals’ identification and management are a true challenge.

Case Report: A 41-year-old male complaining from pain in mandibular left second molar, Clinical and radiographic examinations revealed that there was a large carious lesion and bifurcation and peri-radicular bone resorption with a pocket draining pus. The mandibular left second molar was diagnosed to have a necrotic pulp and symptomatic apical-periodontitis with secondary periodontal-lesion involving large intra-radicular bone resorption. Scaling and root planning were done. Using a dental operating microscope identified a furcation canal upon access cavity; Canals were prepared-and filled with CaOH. On the second visit NaOCl Irrigation was activated and canals were obturated by utilizing a bio-ceramic sealer. The furcation canal was sealed with Well-Root bio-ceramic Putty. After 10-week follow-up the patient was asymptomatic. Radiographic examination revealed bone-deposition in inter-radicular region. At 6 months the tooth was pain-free and functioning.
Conclusion: An interdisciplinary approach to treat endo-perio lesions is mandatory to ensure-favorable outcomes. The presence of furcation canals has a notable impact on the prognosis of endodontic treatments. Proper root canal shaping, disinfection as well as identification of Furcation-canals and their effective sealing are crucial steps in management of infection of endodontic origin-and ensuring treatment success.