Periodontal regeneration, maxillary sinus lesion, and implantology: treatment of a complex case

Periodontitis is one of the most prevalent chronic oral diseases and, if left untreated, may result in tooth loss and systemic complications. Complex cases often require interdisciplinary management. Case reports play an important role in illustrating diagnostic and therapeutic strategies when multiple pathologies coexist. We report the case of a 74-year-old male patient with generalized periodontitis stage III grade B. Clinical and radiographic examination revealed pronounced horizontal and vertical bone loss, chronic apical periodontitis at tooth 44, and an endodontic-periodontal lesion at tooth 25. Initial therapy included professional mechanical plaque removal, oral hygiene instruction, subgingival instrumentation, and endodontic treatments. Despite partial improvement, persistent pathology required regenerative periodontal surgery. Six months later, tooth 25 showed persistent inflammation, and cone-beam computed tomography (CBCT) revealed a soft tissue mass in the left maxillary sinus and an apical lesion at tooth 26. A two-stage surgical approach was adopted, including extraction of tooth 25, ridge preservation with autogenous bone and platelet-rich fibrin, sinus surgery (histology: mucocele), apicoectomy of tooth 26, and implant placement in the 25 region. The implant was restored with a screw-retained zirconia crown after successful osseointegration. Healing was uneventful, and the patient was enrolled in supportive periodontal therapy (SPT) with three- to four-month recalls. This case illustrates the importance of individualized, interdisciplinary treatment planning in advanced periodontitis with concomitant endodontic and sinus pathologies. Three-dimensional imaging proved essential for accurate diagnosis and treatment planning.