{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:38:48Z","timestamp":1760060328753,"version":"build-2065373602"},"reference-count":36,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T00:00:00Z","timestamp":1756166400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dentistry Journal"],"abstract":"<jats:p>Background: The endodontic management of patients with complex systemic conditions represents a significant clinical challenge, particularly in cases involving combined endodontic-periodontal lesions and extensive root resorptions. This case report, accompanied by a recent and targeted literature analysis, describes the single-session treatment of an oncologic patient with multiple systemic comorbidities, presenting with a communicating periapical and endodontic-periodontal lesion (EPL), as well as external cervical root resorption (ECR). Methods: Root canal treatment (RCT), combined with ECR repair, was performed using bioceramic materials, via thorough management and planning with cone-beam computed tomography (CBCT) and the aid of an operating microscope. Results: At the 12-month follow-up, complete clinical and radiographic healing was observed, including regeneration of the periodontal ligament and full functional recovery of the tooth. Conclusions: Contrary to what has been reported in the literature, where several studies highlight lower healing rates in patients with systemic comorbidities undergoing endodontic treatment, the present case report demonstrates a favorable and stable outcome. Moreover, the possibility of concentrating the intervention into a single session represents an additional advantage for this category of patients, who often face limited physical and temporal resources due to their concurrent oncologic condition.<\/jats:p>","DOI":"10.3390\/dj13090388","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T10:35:17Z","timestamp":1756204517000},"page":"388","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Single-Visit Endodontic Management of a Complex Endo-Periodontal Lesion in an Oncologic Patient with Systemic Comorbidities: A 12-Month Case Report"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-3449-4545","authenticated-orcid":false,"given":"Salvatore","family":"Distefano","sequence":"first","affiliation":[{"name":"Centro Odontoiatrico Distefano s.r.l., 95128 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9122-5578","authenticated-orcid":false,"given":"Francesco","family":"Bellucci","sequence":"additional","affiliation":[{"name":"Private Practice, 83100 Avellino, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6910-3118","authenticated-orcid":false,"given":"Salvatore","family":"La Rosa","sequence":"additional","affiliation":[{"name":"Private Practice, 95100 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Evola","sequence":"additional","affiliation":[{"name":"General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Ges\u00f9 5, 95100 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmelo","family":"Federico","sequence":"additional","affiliation":[{"name":"Private Practice, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9006-7262","authenticated-orcid":false,"given":"Giovanni","family":"Barbagallo","sequence":"additional","affiliation":[{"name":"Private Practice, 95100 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Sammarco","sequence":"additional","affiliation":[{"name":"Italian Academy of Microscopic Dentistry (AIOM), Via Andrea Anfossi 57, 92010 Lampedusa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0918-0103","authenticated-orcid":false,"given":"Pietro Valerio","family":"Foti","sequence":"additional","affiliation":[{"name":"Department of Medical Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University of Catania, 95123 Catania, Italy"},{"name":"Radiology I Unit, University Hospital Policlinico \u201cG. Rodolico-San Marco\u201d, Via Santa Sofia 78, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.joen.2024.11.012","article-title":"Controlling Root Canal Infection in Oncological Patients with Apical Periodontitis","volume":"51","author":"Romeiro","year":"2025","journal-title":"J. Endod."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1111\/iej.13789","article-title":"Impact of systemic health on treatment outcomes in endodontics","volume":"56","author":"Cintra","year":"2023","journal-title":"Int. Endod. J."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Niazi, S.A., and Bakhsh, A. (2022). Association between Endodontic Infection, Its Treatment and Systemic Health: A Narrative Review. Medicina, 58.","DOI":"10.3390\/medicina58070931"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"60","DOI":"10.3892\/ijmm.2023.5263","article-title":"Interaction between apical periodontitis and systemic disease (Review)","volume":"52","author":"Ye","year":"2023","journal-title":"Int. J. Mol. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.joen.2024.11.008","article-title":"Association of Apical Periodontitis with Glycated Hemoglobin Levels and Systemic Inflammatory Markers in Patients with Type 2 Diabetes: A Cross-Sectional Study","volume":"51","author":"Dhamija","year":"2025","journal-title":"J. Endod."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1038\/s41368-024-00312-0","article-title":"Expert consensus on endodontic therapy for patients with systemic conditions","volume":"16","author":"Xu","year":"2024","journal-title":"Int. J. Oral. Sci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1111\/iej.13231","article-title":"The effect of an intraorifice barrier and base under coronal restorations on the healing of apical periodontitis: A randomized controlled trial","volume":"53","author":"Kumar","year":"2020","journal-title":"Int. Endod. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1016\/j.joms.2021.08.158","article-title":"The Role of C-Reactive Protein and White Blood Cell Count as Diagnostic, Prognostic, and Monitoring Markers in Bacterial Orofacial Infections","volume":"80","author":"Muna","year":"2022","journal-title":"J. Oral. Maxillofac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1038\/s41415-025-8335-x","article-title":"Endodontic S3-level clinical practice guidelines: The European Society of Endodontology process and recommendations","volume":"238","author":"Duncan","year":"2025","journal-title":"Br. Dent. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1038\/s41368-024-00320-0","article-title":"Expert consensus on the diagnosis and therapy of endo-periodontal lesions","volume":"16","author":"Chen","year":"2024","journal-title":"Int. J. Oral Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1038\/s41415-025-8327-x","article-title":"Management of the endodontic-periodontal lesion","volume":"238","author":"Niazi","year":"2025","journal-title":"Br. Dent. J."},{"key":"ref_12","first-page":"Zg01","article-title":"MTA versus Biodentine: Review of Literature with a Comparative Analysis","volume":"11","author":"Kaur","year":"2017","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1111\/aej.12714","article-title":"Resistance to fracture of simulated external cervical resorption cavities repaired with different materials","volume":"49","year":"2023","journal-title":"Aust. Endod. J."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Subhi, H., Subhi, N., Alhaidary, S., Azeez, M.S., and Tabnjh, A.K. (2024). Antibacterial activity of biodentine against Enterococcus faecalis: A systematic review. Front. Dent. Med., 5.","DOI":"10.3389\/fdmed.2024.1498353"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2025","DOI":"10.1111\/iej.13600","article-title":"Biological interactions between calcium silicate-based endodontic biomaterials and periodontal ligament stem cells: A systematic review of in vitro studies","volume":"54","author":"Sanz","year":"2021","journal-title":"Int. Endod. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"352","DOI":"10.14744\/eej.2024.60783","article-title":"Application of Three Types of Scaffolds in Pulp Regeneration for Permanent Mature Teeth with Periapical Lesions: A Randomized Controlled Trial","volume":"9","author":"Alshahhoud","year":"2024","journal-title":"Eur. Endod. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"6757","DOI":"10.1007\/s00784-023-05288-5","article-title":"Comparative biological properties of resin-free and resin-based calcium silicate-based endodontic repair materials on human periodontal ligament stem cells","volume":"27","author":"Saber","year":"2023","journal-title":"Clin. Oral. Investig."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"3568","DOI":"10.1038\/s41598-024-53872-w","article-title":"Biocompatibility of mineral trioxide aggregate and biodentine as root-end filling materials: An in vivo study","volume":"14","author":"Nabeel","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1111\/iej.13715","article-title":"Present status and future directions: Root resorption","volume":"55","author":"Patel","year":"2022","journal-title":"Int. Endod. J."},{"key":"ref_20","first-page":"124","article-title":"Invasive cervical resorption: A review","volume":"5","author":"Kandalgaonkar","year":"2013","journal-title":"J. Int. Oral. Health"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1111\/iej.12824","article-title":"External cervical resorption: A three-dimensional classification","volume":"51","author":"Patel","year":"2018","journal-title":"Int. Endod. J."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Distefano, S., Cannarozzo, M.G., Spagnuolo, G., Bucci, M.B., and Lo Giudice, R. (2023). The \u201cDedicated\u201d C.B.C.T. in Dentistry. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20115954"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1038\/sj.bdj.2014.204","article-title":"Irrigation in endodontics","volume":"216","author":"Haapasalo","year":"2014","journal-title":"Br. Dent. J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1111\/aej.12549","article-title":"Multispecies biofilm removal by XP-endo Finisher and passive ultrasonic irrigation: A scanning electron microscopy study","volume":"48","author":"Teves","year":"2022","journal-title":"Aust. Endod. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e936569","DOI":"10.12659\/MSM.936569","article-title":"Radiological Assessment of Prevalance and Quality of Periapical Status of Endodontic Treatments","volume":"28","author":"Aysal","year":"2022","journal-title":"Med. Sci. Monit."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1038\/s41432-023-00954-9","article-title":"Dose\u2013response association of smoking with delayed healing of apical periodontitis after endodontic treatment","volume":"24","author":"Majid","year":"2023","journal-title":"Evid.-Based Dent."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1111\/j.1365-2591.2012.02083.x","article-title":"Bioactivity of EndoSequence root repair material and bioaggregate","volume":"45","author":"Shokouhinejad","year":"2012","journal-title":"Int. Endod. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1111\/j.1365-2591.2011.01924.x","article-title":"Uptake of calcium and silicon released from calcium silicate-based endodontic materials into root canal dentine","volume":"44","author":"Han","year":"2011","journal-title":"Int. Endod. J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/j.joen.2019.10.032","article-title":"Histologic Response of Human Pulp and Periapical Tissues to Tricalcium Silicate-based Materials: A Series of Successfully Treated Cases","volume":"46","author":"Ricucci","year":"2020","journal-title":"J. Endod."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1016\/j.joen.2014.11.005","article-title":"Healing after root-end microsurgery by using mineral trioxide aggregate and a new calcium silicate-based bioceramic material as root-end filling materials in dogs","volume":"41","author":"Chen","year":"2015","journal-title":"J. Endod."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1612","DOI":"10.1016\/j.joen.2024.08.015","article-title":"Chemical, Antibacterial, and Cytotoxic Properties of Four Different Endodontic Sealer Leachates Over Time","volume":"50","author":"Chen","year":"2024","journal-title":"J. Endod."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"(2006). Quality guidelines for endodontic treatment: Consensus report of the European Society of Endodontology. Int. Endod. J., 39, 921\u2013930.","DOI":"10.1111\/j.1365-2591.2006.01180.x"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/iej.12014","article-title":"Terminology of endodontic outcomes","volume":"46","author":"Messer","year":"2013","journal-title":"Int. Endod. J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2799","DOI":"10.1111\/odi.14449","article-title":"Medication-related osteonecrosis of the jaw triggered by endodontic failure in oncologic patients","volume":"29","author":"Tempesta","year":"2023","journal-title":"Oral. Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1016\/j.acvd.2017.01.012","article-title":"Position paper for the evaluation and management of oral status in patients with valvular disease: Groupe de Travail Valvulopathies de la Soci\u00e9t\u00e9 Fran\u00e7aise de Cardiologie, Soci\u00e9t\u00e9 Fran\u00e7aise de Chirurgie Orale, Soci\u00e9t\u00e9 Fran\u00e7aise de Parodontologie et d\u2019Implantologie Orale, Soci\u00e9t\u00e9 Fran\u00e7aise d\u2019Endodontie et Soci\u00e9t\u00e9 de Pathologie Infectieuse de Langue Fran\u00e7aise","volume":"110","author":"Millot","year":"2017","journal-title":"Arch. Cardiovasc. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Al-Marzooq, F.I., and Christidis, N. (2025). The interconnection of oral and systemic health. Sci. Rep., 15.","DOI":"10.1038\/s41598-025-98718-1"}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/13\/9\/388\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:32:56Z","timestamp":1760034776000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/13\/9\/388"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,26]]},"references-count":36,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["dj13090388"],"URL":"https:\/\/doi.org\/10.3390\/dj13090388","relation":{},"ISSN":["2304-6767"],"issn-type":[{"type":"electronic","value":"2304-6767"}],"subject":[],"published":{"date-parts":[[2025,8,26]]}}}