Evaluation of Effectiveness of Chlorhexidine Intracanal Medicament on Periodontal Healing in Concomitant Endodontic and Periodontal Disease With Communication : A Randomized Controlled Clinical Trial

INTRODUCTION:

Treatment decision-making and prognosis of endodontic-periodontal lesion is primarily dependent on the diagnosis of the specific endodontic or periodontal disease. Although the treatment of endodontic and periodontal lesions arouse a lot of confusions and speculations. Wherein, endodontic-periodontal combined lesion is a clinical dilemma because making a differential diagnosis and deciding a prognosis are difficult. Also, the success of such lesions depends on the elimination of both of these disease processes as the endodontic therapy results in healing of the endodontic component of involvement while the prognosis of tooth would finally depend on the healing of the periodontal structures.

Interventional studies also reported negative influence on the periodontal healing in presence of infected root canal system, after providing periodontal treatment. However, in addition to this, the outcome of endodontic treatment may be affected if the root canal filling is placed while there is still a periodontal infection present that communicates with the root canal system since cross-seeding through the apical or lateral foramina is possible. Despite thorough cleaning and disinfection of the root canal system during endodontic treatment, bacteria from the periodontal lesion may re-invade the root canal system since root canal fillings do not seal canals completely.

The elimination of microorganisms from infected root canal is a complicated task involving the use of various instrumentation techniques, irrigation regimens and intracanal medicaments. Gomes et al observed that 2% chlorhexidine (CHX) showed maximum zone of inhibition against porphyromonas gingivalis, enterococcus faecalis, actinomyces viscosus and candida albicans followed by a combination of calcium hydroxide and CHX, and least with calcium hydroxide alone. A clinical study carried out by zamany et al showed that 2% CHX solution used as a final irrigant, significantly decreased bacterial loads in root canal. Additional advantages of chlorhexidine are its retentive character in root canal dentin and its relatively low toxicity and its effect on periodontal healing has been well known. Based on these observations, it may be hypothesized that intracanal medicament may act as a controlled released drug which could be used as an adjunct to periodontal surgical therapy .

Thus the present study was conducted to evaluate the effectiveness of chlorhexidine intracanal medicament along with periodontal surgical therapy on periodontal healing in concomitant endodontic and periodontic disease with communication.