75 Two types of endo-perio lesions in mouth Maria Davina 1 and Dewi Anggraini Margono 2 1 Resident of Conservative 2 Lecturer of Conservative Dentistry, Indonesia University Correspondence: Maria Davina, Department of Conservative Dentistry, Faculty of Dentistry, Indonesia University, email: mariajoelimar@yahoo.com ABSTRACT Background: Endo-perio lesion is responsible for more than 50% of tooth necrosis. This lesion manifests from embryonic, anatomical, and functional interrelationships between pulp and periodontium. There are few types of endo-perio lesion based on the variations in etiology and pathogenesis. Purpose: The purpose of this article is to describe the managements of an endo-perio lesion with holistic treatments, including endodontic and periodontal. Case: A 40 years old female patient came with major complaint on her right maxillary molar. The gingiva in the region had been swollen intermittently followed by a dull pain since the last few months. The additional complaint was on the left maxillary molar which had a similar swelling and pain history, only the frequency was less. The tooth 16 was non-caries, non-vital, positive in percussion and palpation, 2° mobility, and extruded. The gingival was inflamed and there was a wide deep pocket toward apex at palatal. From radiograph, there was an apical radiolucency +6mm in diameter, involving all roots. The tooth was diagnosed as chronic dentoalveolar abscess due to pulp necrosis from traumatic occlusion. Its classification was “true combined lesion”. While tooth 26 is vital with gingival recession at palatal and wide deep pocket at mesial. The tooth was diagnosed as chronic periodontitis, classified as “primary periodontal lesion”. Case management: The treatments of tooth 16 were elimination of etiology followed by endodontic and periodontal treatments (flap operation). While for tooth 26, only periodontal treatment is indicated. After endodontic treatment, tooth 16 showed a great healing (no subjective complaint, no mobility, normal response in percussion and palpation) but only on endodontic lesion, while the pockets were still deep (8 mm became 6 mm). Only after periodontal treatment with flap operation the pocket depths were reduced greatly (6 mm became 3 mm). Conclusion: Different type of endo-perio lesion requires different treatment planning. The success of the managements of a combined lesion, as represented by tooth 16, depends on both endodontic and periodontal treatments as well as holistic approaches. Key words: Endo-perio lesion, traumatic occlusion INTRODUCTION Interrelationship between pulpal and periodontal diseases, known as “endo-perio lesion”, has been a controversy for over 100 years. 1 Bender 2 and Chen 3 stated that pulpal and periodontal problems are responsible for more than 50% of tooth necrosis. This complex lesions are manifested from embryonic, anatomic, and functional interrelationships between pulp and periodontium. 4,5 They are frequently asymptomatic for a long time, resulting in late detection until the symptoms of acute inflammation appear. Sometimes, these lesions are detected intuitively from routine check up. 5 Vol. 59, No. 3, September-Desember 2010, Hal. 75-82 | ISSN 0024-9548