Fig. 1

A 40 years old patient was referred to me by a periodontolgist who had diagnosed a primary periodontal lesion, with a deep probing on the palatal and distal aspect of tooth 2.7

The tooth was symptomatic and positively responding to pulp sensibility tests. 

The request of the period ontologist was to do the endodontic treatment before the periodontal intervention, since the lesion was involving the apex of the root and some sign of pulp degeneration were present. 

The tooth was isolated with rubber dam. The existing onlay was considered good, so the access cavity was done through the restoration. 

A diamod coated tapered bur was used, followed by an ultrasonic tip. 

The pulp was in an inflamed state, with profuse bleeding. 

Once the three main canals were visible, a full mechanical pre flaring was done with Fanta AF-F One 13/.03, 20/.04, 25/.06. 

The rotary file was inserted into the root canals without applying any pressure, 5 mm short from the estimated working length

Appearance of the tooth after preflaring

After recording the working length and establishing a glide path, the canals were shaped to the working length by Fanta Af-F One Style Italiano Endodontics selection

The visual gauging helped to determine the final size of the apical preparation

The root canals were irrigated with NaOCl, acitvated by US tips, then rinsed with sterile water and irrigated again with EDTa, also activated by US tips. In the end the canal was rinsed with sterile water. 

Fig. 2

Intra operative x-ray with cone fit 

The tooth was obturated with single cone + tricalcium silicate based sealer

Fig. 3

The access cavity was restored in the same appointment

Fig. 4

The symptoms of the patient disappeared within 24 hours; the week after the endodontic treatment she received the periodontal nonsurgical treatment. 


A correct diagnosis and a multidisciplinary approach are the key to approach correctly endo-perio lesions. 

The use of strict protocols is mandatory to achieve a successful outcome. 


Didilescu AC, Rusu D, Anghel A, Nica L, Iliescu A, Greabu M, et al. Investigation of six selected bacterial species in endo-periodontal lesions. Int Endod J. 2012;45(3):282-93.

Gandhi A, Kathuria A, Gandhi T. Endodontic-periodontal management of two rooted maxillary lateral incisor associated with complex radicular lingual groove by using spiral computed tomography as a diagnostic aid: a case report. Int Endod J. 2011;44(6):574-82.

Oktawati S, Siswanto H, Mardiana A, Neormansyah I, Basir I. Endodontic–periodontic lesion management: A systematic review. Medicina Clínica Práctica. 2020;3.

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