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

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.