Surgical treatment for severe endodontic-periodontal lesion - A case report with 2-year follow-up

Oct 2, 2026

A case report evaluates periodontal regeneration for an endodontic-periodontal lesion using a flexible tunnel technique (FTT) with a 2-year follow-up. The approach targets infrabony defects extending toward the root apex on the palatal side without incising the interdental papillae. In a 66-year-old patient, vertical incisions and periosteal release improve surgical access, enabling debridement, enamel matrix derivative application, and filling with deproteinized bovine bone mineral. Outcomes include pocket closure, bone defect improvement, no gingival recession, and stable tissue maintenance without complications through two years.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusions

Key points

Plain language summary

Introduction

Received: 25 October 2024 Accepted: 26 December 2024 DOI: 10.1002/cap.10341 CASE STUDY Surgical treatment for severe endodontic-periodontal lesion: A case report with 2-year follow-up Yoshitaka Nara1 Lorenzo Tavelli2 Shogo Maekawa3 1 Nara Dental Clinic, Chigasaki, Japan 2 Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA 3 Department of Periodontology, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Tokyo, Japan Correspondence Yoshitaka Nara, Nara Dental Clinic, 20-1 Saiwaichou, Chigasaki 253-0052, Kanagawa, Japan. Email: [narayo69@gmail.com](narayo69@gmail.com) Shogo Maekawa, Department of Periodontology, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan. [Email:](Email: maekawa.peri@tmd.ac.jp)[ maekawa.peri@tmd.ac.jp](Email: maekawa.peri@tmd.ac.jp) Abstract Background: Various surgical techniques have recently been developed for periodontal tissue regeneration, especially those do not involve any incisions in the interdental papillae at the regeneration site. These techniques have significant advantages for obtaining clinical attachment gain with least amount of gingival recession, however, may also have disadvantages such as limited field of surgical view, difficulty in debridement, and limited access only from the buccal side. This case report addresses a 2-year follow-up with a novel surgical approach to achieve periodontal regeneration that overcomes these limitations: the flexible tunnel technique (FTT) . Methods: In a 66-year-old patient, in an enclosing infrabony defect extending to the root apex on the palatal side, which appeared to be an endodonticperiodontal lesion on tooth \#5, four vertical incisions and a periosteal releasing incision were performed in order to make the interdental papillae easier to translocate over the abutment teeth, which led to obtain clearer operative field. After debridement, the enamel matrix derivative was applied to the root surface and the infrabony defect was filled with deproteinized bovine bone mineral. The flaps were relocated, and simple interrupted sutures were performed. Results: One year later, pocket closure and improvement of bone defects were observed without gingival recession. After confirmation with improved mobility, a full zirconia crown was placed. During 2-year follow-up, periodontal tissue was maintained well without any complication. Conclusions: The FTT can be used to approach endodontic-periodontal lesions and infrabony defects extending to the root apex without incision of the interdental papillae. KEYWORDS alveolar bone loss, dental papillae, enamel matrix proteins, guided tissue regeneration, periodontal, tooth, nonvital Key points ∙ A more accessible tunnel technique can be performed by using four vertical incisions. ∙ If the tooth is abutment, interdental papillae can be flexible to translocate due to this tunnel technique with vertical incisions. ∙ Ensuring root surface debridement, application of regenerative materials, and wound stability are the keys to this regenerative procedure. ∙ The patient needs to understand the risks associated with the proposed periodontal regenerative surgery and the prognosis of tooth. ClinAdv Periodontics. 2026;16:115–[123.](123. wileyonlinelibrary.com/journal/cap)[ wileyonlinelibrary.com/journal/cap](123. wileyonlinelibrary.com/journal/cap) © 2025 American Academy of Periodontology. 115 116 NARA ET AL. Plain language summary Various surgical techniques have been developed recently to help regenerate the tissues that support teeth, especially methods that avoid making cuts in the gum tissue between the teeth at the treatment site. However, these techniques may have some drawbacks, such as limited visibility during surgery, difficulty cleaning the area, and access only

FAQs

What clinical limitation of existing regenerative surgical techniques does the flexible tunnel technique aim to overcome?

It aims to avoid cutting the interdental papillae while improving surgical accessibility and operative visibility, and reducing limitations such as restricted field of view and difficulties with debridement.

What procedures were performed in the reported 66-year-old patient?

Four vertical incisions with a periosteal releasing incision were used to facilitate translocation of interdental papillae, followed by debridement, application of an enamel matrix derivative to the root surface, and defect filling with deproteinized bovine bone mineral. Flaps were repositioned and sutured with simple interrupted stitches.

What were the main periodontal outcomes during the 2-year follow-up?

Pocket closure was achieved, bone defects improved, gingival recession was not observed, and periodontal tissue was maintained without complications after the placement of a full zirconia crown.

Oct 2, 2026

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