Combined Endo-perio Lesions Research Articles

Efficacy of Chlorhexidine Intracanal Medicament on Periodontal Healing in Concomitant Endodontic-Periodontal Disease with Communication: A Randomized Clinical Trial

Background: Chlorhexidine has been extensively used in various periodontal and endodontic infections. However its use in combined endo perio lesion has not been defined clearly. The aim of this study was to evaluate the efficacy and synergistic effect of chlorhexidine intra canal medicament with combination of comprehensive periodontal therapy in endodontic periodontal lesions. 
 Materials and Methods: The patients were randomly assigned group 1 and group 2. Both the groups were treated by phase 1 and phase 2 periodontal treatments while group 1patients received conventional root canal treatment and group 2 patients were treated by chlorhexidine intracanal medicament for 6 months. The primary outcome measures are probing pocket depth, relative attachment level and bleeding on probing. 
 Results: Both groups showed improvement on primary outcome measures. However, group 2 showed significant more reduction in probing pocket depth (PPD) and bleeding on probing (BOP) and gain in relative attachment level (RAL) after complete 6 months treatment with chlorhexidine. Postoperative measurements from group1 and group 2 showed reductions in mean PPD of 2.63±0.98 and 3.57±1.13 mm, mean BOP reduction of 76.78±31.41and 87.54±22.35 and mean RAL gains of 2.42±1.27 and 3.42±0.94 mm, respectively. 
 Conclusion: 2% CHX gel used as an intracanal medicament along with periodontal treatment demonstrated more favourable treatment response in terms of periodontal healing.

The morphological and functional relationship between dental pulp and periodontal tissue in the aspect of endo-perio lesions

Relevance. The growing prevalence of combined endo-perio lesions (EPL) attracts the interest of researchers. Insufficiently covered in the scientific literature, issues of the anatomical and functional relationship between periodontal tissues and dental pulp, the lack of an algorithm for diagnosis and treatment of EPL determine the need for their research. The study aimed to arrange the available data on the morpho-functional aspects of the relationship between dental pulp and periodontal tissues and their features that determine the p athogenesis of EPL.Materials and methods. The study found 2875 publications, presented in the international electronic scientific databases PubMed, Google Search, Embase, Web of Science, ScienceDirect, SciELO and eLibrary. Following the inclusion and non-inclusion criteria, we selected 52 publications, which included the results on studying the structure and function of periodontal tissues, roots and pulp of teeth in the aspect of EPL development. The methodology of this study meets the criteria for systematic reviews and meta-analyses (PRISMA).Results. In EPL lesions, inflammation is maintained by an infection, which persists in the additional root canals and dentinal tubules and the periodontal pocket. Prevention of the formation and elimination of infection foci in the root canal system of the tooth, periapical tissues and periodontal pockets is the basis for EPL prevention and treatment. At the same time, there are no diagnostic and therapeutic algorithms, which allow timely detection of EPL and adequate treatment, depending on the primary lesion of pulpal and periodontal tissues and individual characteristics of the patient. The structure specifics of roots, pulp, cementum, periodontium and alveolar bone are described. The characteristic features of blood supply and innervation of the pulpal and periodontal tissues are presented. Promising areas of scientific research in EPL prevention and treatment are identified.Conclusion. Tooth pulp and periodontal tissues are closely related morphologically and functionally. They are principally connected through the apical foramina and additional canals. Bacterial infection can also penetrate the pulp and periodontal tissues from the infected root canal system of the tooth through the dentinal tubules of the tooth root.

Biodentine and Amniotic Membrane to Treat the Hidden Villain- A Rare Case of Labiocervical Vertical Groove

This case report signifies the importance of complications and early diagnosis of radicular groove and to discuss the treatment of combined endo-perio lesion using bone graft mixed with Platelet Rich Fibrin (PRF), amniotic membrane and biodentine. Labiocervical Vertical Groove (LCVG) presents various complications to the patients, especially if it extends to the pulpal space. Labiocervical vertical groove originating near the cervical area of tooth can extend to the radicular surface. These grooves can be mild, moderate or deep based on its extent and depth. This case report deals with the complications, degree of destruction and treatment of an intrabony defect associated with LCVG in maxillary central incisor in a 35-year-old male patient, who reported to the Department of Periodontics and Implantology with the chief complaint of mobility of teeth over a period of past 2 months. In this case report, authors have highlighted the advantages of saucerization, PRF, Amniotic membrane and biodentine to treat the bone loss along with restoration of the groove.

'Combined endo-perio lesions' - what is the best treatment?

Aims To assess the radiographic and periodontal healing of combined endo-perio lesions in anterior teeth treated with orthograde root canal treatment (RCT), with and without guided tissue regeneration (GTR) and bone grafting.Sample selection A total of 120 individuals attending the Dental University Hospital in Riyadh, Saudi Arabia, diagnosed with true combined endo-perio lesions were selected. Inclusion criteria included being between 25 and 55 years old and having a single-rooted non-vital maxillary anterior tooth with a true combined endo-perio lesion, assessed using a cone beam computed tomography (CBCT) scan. Exclusion criteria included uncontrolled systemic disease, a history of oral cancer or sepsis, recent use of antibiotics, the use of bone metabolism modifying drugs and the presence of fractures, resorption or associated pathological cysts. Power calculations were used to set a minimum sample size of 120 teeth.Design A randomised controlled trial involving four treatment arms: root canal treatment (RCT) with gutta percha (GP) obturation; RCT with mineral trioxide aggregate (MTA) obturation; RCT with GP obturation and guided tissue regeneration (GTR); and RCT with MTA obturation and GTR. Participants were randomly assigned using computer software to each treatment arm via block randomisation.Baseline periodontal measurements (gingival phenotype, keratinised tissue width, pocket depth and clinical attachment level) and a CBCT scan to obtain a CBCT periapical index (CBCTPAI) score were taken at visit one. Visit two involved scaling, root planing and a RCT performed using hand files and a thermoplastic obturation technique for the GP obturation arm (Obtura II, Obtura Spartan, USA) and vertical compaction for the MTA obturation arm (ProRoot White, Dentsply, USA). Visit three (for the GTR and bone-grafting arms), one week later, included regenerative periodontal surgery - raising a three-sided buccal flap, removal of granulation tissue, filling the defect with demineralised, freeze-dried bone allograft, coverage with a resorbable collagen membrane and closure with resorbable sutures. Visit two was performed by a single endodontist and visit three, for the GTR and bone grafting arms, was performed by a single periodontist. Previous or future planned treatment was concealed to operators and they were only informed of the treatment to be performed on the day. All teeth received definitive restorations.The follow-up schedule was one, three, six and twelve months post-treatment. CBCT scans were repeated at six and twelve months; clinical periodontal measurements were repeated at three, six and twelve months.Data analysis Descriptive analysis was performed and results were presented as cross-tabulations and a bar chart. Inferential statistics were used; one-way analysis of variance with Tukey's multiple comparison test to compare the mean value of measurements between treatment arms at follow-up visits and Kruskal-Wallis test to compare mean CBCTPAI scores between arms at follow-up visits. The p-value was set at ≤0.05.Results Baseline comparison showed no statistically significant differences between treatment arms. No participants were lost to follow up. At 12 months, GTR showed improved healing, with 98% of cases showing CBCTPAI scores better than 1, compared to 100% cases scoring 1 + D or worse without GTR. Statistically significant differences were found between treatment arms with respect to CBCTPAI score and pocket depth at 12 months.Conclusions GTR may improve radiographically-assessed healing of combined endo-perio lesions. MTA obturation may play a role in the management of combined endo-perio lesions. Study limitations do not allow for more definitive conclusions.

Regenerative Therapy Modality for Treatment of True Combined Endodontic-Periodontal Lesions: A Randomized Controlled Clinical Trial.

The aim of this in-vivo study was to evaluate/compare the clinical periodontal parameters in patients with true combined endo-perio lesions (EPL), treated with gutta-percha (GP) and mineral trioxide (MTA) as an obturation material alone and with addition of bone grafting in such lesions. 120 Saudi patients (mean age = 41yrs) diagnosed with true combined EPL participated in this study. Group I (control group, n = 30) was treated with conventional endodontic treatment using GP for obturation. Group II (n = 30) was treated with conventional endodontic treatment using MTA for obturation. Group III (n = 30) was treated with conventional endodontic treatment using GP for obturation + grafting procedure to fill the bony defect. Group IV (n = 30) was treated with conventional endodontic treatment using MTA for obturation + grafting procedure to fill the bony defect. Clinical parameters (Pocket depth (PD); Clinical attachment loss (CAL); keratinized tissue width (KTW); gingival phenotype (G.Ph.) and Cone Beam Computed Tomography Periapical Index (CBCTPAI)) were recorded and compared at baseline, 3, 6, 12 months’ interval. For the groups III and IV, CBCTPAI showed significant difference (p < 0.0001) with the other groups at 6 months and 1-year interval. The group with MTA + bone graft showed 76% and 90% patients with 0 score at 6 months and 1-year follow-up, respectively. Comparison of mean values of PD among study groups at 3 months, 6 months and 1 year showed significant difference at 3 months, whereas the mean PD values of subjects in GP + bone graft showed significantly higher PD values than other 3 groups (p = 0.025). Use of GP and MTA for root canal obturation along with periodontal therapy and bone augmentation helps in resolving complex endo-perio lesions. Bone grafting in addition to obturation with MTA was found to be the best treatment strategy in management of EPL cases and is recommended for clinicians who are treating EPL patients.

Injectable platelet-rich fibrin-“a quicker therapeutic aid” in the treatment of combined endo-perio lesion: A case report

Injectable platelet-rich fibrin-“a quicker therapeutic aid” in the treatment of combined endo-perio lesion: A case report

Effect of immediate periodontal surgical treatment on periodontal healing in combined endodontic–periodontal lesions with communication—A randomized clinical trial

Background and objectiveManagement of combined endodontic–periodontal lesions needs more clinical investigations. The aim of this prospective randomized clinical trial was to evaluate the effect oftime interval between the non-surgical endodontic treatment (ET) and open flap debridement (OFD) on periodontal healing in combined endodontic periodontal lesions with apical communication. MethodsForty patients were randomly allocated to two treatment protocols. Group 1(immediate periodontal surgery): OFD was performed at 21days of initiation of ET and SRP, and Group 2(delayed periodontal surgery): OFD was performed after 3 months of initiation of ET and SRP. The primary parameters included probing pocket depth (PPD), relative attachment level (RAL) and bleeding on probing (BOP) and tooth mobility (TM). ResultsSignificantly more reduction in PPD, TM and gain in RAL was observed in Group 1 at 3 months of OFD. (P<0.05) Whereas at 6 months follow up of OFD (6 and 9 months of ET in Group1 and Group 2, respectively), intergroup analysis showed statistically comparable reduction in BOP (%), PPD, TM and gain in RAL (P>0.05) in both the groups. ConclusionImmediate periodontal surgery may not affect the outcome of the treatment of combined endo-perio lesions with apical communication.

Surgical Management of Endo-Perio Lesion with Demineralised Bone Matrix in Combination with Platelet Rich Fibrin: A Case Report

Periodontal disease is a chronic inflammatory disease process that eventually leads to loss of periodontal attachment and an eventual, bone destruction. The objective of periodontal therapy is to regenerate the lost periodontal tissues. Platelets are rich in growth factors that may contribute to an accelerated process of tissue regeneration. Demineralised bone matrix, (DMBM) xenograft is a bone inductive, sterile, bioresorbable, graft composed of Type I collagen. Given the unique properties of autologous platelet rich fibrin (PRF) and already demonstrated regenerative capacity of commercially available bone grafts, application of a combination approach was attempted. We herewith present a case report of a combined endo-perio lesion that was treated by a combination of autologous PRF and bovine derived xenograft, assessed clinically and radiographically.

Interdisciplinary management of a two-rooted mandibular first premolar with furcation involvement: A 2-year follow-up

Consistent knowledge of developmental anomalies along with careful clinical and radiographic interpretation is essential pre-requisites for successful management. This case describes a 2-year follow-up of a case with carious mandibular right first premolar with two roots, three root canals and a deep periodontal probing depth along with an early Grade II furcation involvement. The tooth was endodontically treated followed by periodontal surgery, to eliminate the pocket and promote bone fill in the osseous and furcation defect. Hydroxyapatite graft composited with bioactive glass was utilized for enhancing bone formation. Clinical Relevance to Interdisciplinary Dentistry Detailed knowledge of root anomalies in mandibular premolars is a pre-requisite for successful management of combined endo-perio lesions. Periodontal regenerative procedure using hydroxyapatite graft can be performed to enhance bone formation. Use of radiographs and advanced diagnostic aids are recommended for clinical evaluation of tooth anomalies.

NON-SURGICAL ENDODONTIC MANAGEMENT OF THE COMBINED ENDO-PERIO LESION: REPORT OF THREE CASES'

Endodontic-periodontal lesions offer a constant challenge to the clinician for diagnosis, treatment and prognosis of the teeth that are of great concern. Treatment and prognosis of endodontic-periodontal diseases vary depending on the cause and the correct diagnosis of each specific condition. This article presents successful healing of combined endo-perio lesions after non-surgical endodontic management with long term follow up.

Application of Hounsfield Unit to evaluate Prognosis of a Rehabilitated Tooth with Grade Three Mobility

ABSTRACT The relationship between pulpal and periodontal disease was first described by Simring and Goldberg in 1964. Pathological agents pass between the pulp and periodontium, thereby creating the endoperio lesion. Lateral canals play an important role in the spread of infection from pulp to periodontium. This article reports a case of a 38-year-old patient with a combined endoperio lesion. Bone density is a key factor in predicting bone healing. Application of Hounsfield unit to determine the healing pattern of bone. How to cite this article Hegde MN, Hegde ND, Shrivastava D. Application of Hounsfield Unit to evaluate Prognosis of a Rehabilitated Tooth with Grade Three Mobility. World J Dent 2012;3(1):109-111.

A modified horizontal gingival incision: An approach to endo-perio lesion - two case reports

Combined Endo-Perio lesions are treated with root canal therapy & periodontal flap surgeries, to rid off endodontic and periodontal lesions respectively. Clinical observations have revealed that the conventional flap techniques employed in the treatment of such conditions resuit in to loss of Inter dental papillae (IDP) & marginal gingiva to a certain degree, leading to open embrasures/recessions that pose problems of food lodgment eventuating in to periodontal problems again. Thus, iatrogenicaly induced open embrasures & food lodgments jeopardize the success of dental therapy. In view of this, a clinical trial has been carried out with an Objective of assessing whcthcr ‘Modificd Horizontal Gingival Incision’ could overcome afore mentioned postoperative sequelae associated with conventional envelope flap techniques. Materials and methods included 20 combined endo-perio lesions that were randomly treated by either of the techniques. Results showed signiflcant loss of IDP as measured through Papilla Index Scores (PIS), followed by food lodgment due to conventional envelope flap techniques, where as the Modified Horizontal Gingival Incision alleviated any such sequelae. Hence it was concluded that this technique successfully aided in preservation of IDP.

A sequential approach in treatment of perio-endo lesion

The success of a combined periodontal and endodontic lesion depends on the elimination of both of these disease processes. In the case of a combined endo-perio lesion, 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. This case report evaluates the efficacy of bioactive glass in the management of furcation defect associated with an endo-perio lesion in a right mandibular first molar. A 22-year-old male patient with an endo-perio lesion in the right mandibular first molar was initially treated with endodontic therapy. Following the endodontic treatment, the furcation defect was treated using bioactive glass in a putty form. At the end of 9 months, there was a gain in the clinical attachment level and reduction in probing depth. Radiographic evidence showed that there was a significant bony fill.

Combined endodontic - Periodontal lesion: A clinical dilemma

Endodontic-periodontal combined lesion is a clinical dilemma because making a differential diagnosis and deciding a prognosis are difficult. Lesions of the periodontal ligament and adjacent alveolar bone may originate from infections of the periodontium or tissues of the dental pulp. Periradicular bone loss secondary to endodontic pathosis is typically seen in teeth with necrotic pulps. The ultimate goal of periodontal therapy is not only to maintain the natural dentition, but also to restore lost periodontium. Combined periodontal and endodontic diseases involve the periodontal attachment apparatus. The treatment of endodontic-periodontal combined lesions requires both endodontic therapy and periodontal regenerative procedures. With advancements in new techniques and materials different treatment choices are available, providing a superior prognosis. This article includes case reports of combined endo-perio lesions which were first treated with conventional endodontic therapy and then followed by periodontal surgery. This combined treatment resulted in a radiographical evidence of alveolar bone gain. This case report demonstrates that proper diagnosis, followed by removal of etiological factors and utilizing the combined treatment modalities will restore health and function to the teeth with severe attachment loss caused by an endo-perio lesion.