Combined Periodontal-endodontic Lesions Research Articles

Comparison of the Outcome of Intentional Replantation in Teeth with or without Periodontal Involvement: A Retrospective Study

ObjectiveIntentional replantation (IR) is considered as a viable treatment option to preserve the teeth with apical periodontitis. This study aimed to compare the treatment outcomes of IR in teeth with or without periodontal involvement, and to investigate the influence of related factors. MethodsA total of 157 teeth with a documented history of IR between September 2012 and November 2022 and a follow-up duration of more than 1 year were included. The samples included 100 teeth with simple apical periodontitis and 57 teeth with combined periodontal-endodontic lesions (CPEL). Clinical and radiographic criteria were used to evaluate treatment outcomes including functional retention and extraction. Chi-square analyses and Fisher's exact tests were used to compare bivariate associations between outcomes and clinical or demographic variables. Kaplan–Meier analyses were used to evaluate the cumulative survival rate of the intentionally replanted teeth. ResultsThe overall cumulative survival rates were 93.0% at 1 year, 76.7% at 5 years, and 56.2% at 10 years. Among the 100 teeth with simple apical periodontitis, the survival rates were 93.0%, 86.7%, and 78.8% at the same time points. In contrast, 57 teeth with CPEL exhibited survival rates of 93.0%, 65.0%, and 36.9%, respectively. The primary postoperative complications that led to extraction were periodontal involvement (51.9%), tooth fracture (18.5%), external root resorption (18.5%), and persistent apical periodontitis (11.1%). The outcomes of teeth with CPEL were significantly affected by the presence of a sinus tract and crown restoration. In contrast, no significant prognostic factors were identified for teeth without periodontal involvement. ConclusionThe long-term prognosis of teeth with CPEL is significantly worse than those with simple apical periodontitis. The main reason of extraction was periodontal involvement. Regular periodontal maintenance and appropriate crown restoration may help to improve the prognosis for teeth with CPEL.

Minocycline hydrochloride ointment combined with Vitapex paste is effective for middle-aged and elderly patients with combined periodontal-endodontic lesions

Minocycline hydrochloride ointment combined with Vitapex paste is effective for middle-aged and elderly patients with combined periodontal-endodontic lesions

Interdisciplinary Management of Palatogingival Groove in Maxillary Lateral Incisor

Palatogingival groove is a developmental anomaly usually affecting maxillary anterior teeth. This is often accompanied by bone destruction adjacent to the teeth with no carious or traumatic history. This groove can harbor plaque and bacteria, resulting in periodontal destruction, endodontic lesions, or combined endodontic-periodontal lesions. Disease severity and prognosis depend on several factors, including location, range, depth, and type of the groove. Several materials have been used and recommended for cases of extensive periodontal destruction to remove and block the inflammatory source and recover the health of surrounding periodontal tissues, hence successfully managing the condition.

Clinical Outcome and Predictors of Endodontic Microsurgery Using Cone-beam Computed Tomography: A Retrospective Cohort Study

IntroductionThe aim of this retrospective cohort study was to evaluate the clinical outcomes and identify the prognostic factors of endodontic microsurgery based on cone-beam computed tomographic (CBCT) scans. MethodsPatients who underwent endodontic microsurgery in teeth with asymptomatic apical periodontitis were included. The clinical outcomes were determined based on clinical and radiographic examinations after surgery 12–48 months. Radiographic healing was assessed on CBCT images by using the modified PENN 3-dimensional criteria and classified into 4 categories: complete, limited, uncertain, and unsatisfactory healing. Multivariate logistic regression was performed to detect outcome risk factors. ResultsOf the 204 teeth in 173 invited patients, 148 teeth of 126 patients were examined at review. On CBCT images, 88 teeth (59.5%) showed complete healing, and 42 (28.4%) teeth showed limited healing. All these 130 teeth were asymptomatic and achieved a clinical success rate of 87.8%. Uncertain healing was observed in 9 teeth, one of which was symptomatic. The remaining 9 teeth were unsatisfactory healing on CBCT scans, including 6 teeth with clinical symptoms and 3 free. Lesion type and root-end filling quality were significant outcome predictors (P < .05). The risk of treatment failure for teeth with combined endodontic-periodontal lesions was 8.6 times higher than that for teeth with isolated endodontic lesions. Adequate root-end filling quality improved the probability of success by 5.3 times. ConclusionsBased on CBCT data, an adequate performed endodontic microsurgery could have predictable success in teeth without periodontal involvement.

Association between odontogenic conditions and maxillary sinus abnormalities: a retrospective cone-beam computed-tomographic study.

In this study, we investigated the correlation between odontogenic conditions and the presence of maxillary sinus (MS) abnormalities using cone-beam computed tomography (CBCT) imaging. The study unit was defined as the ipsilateral MS, maxillary alveolar bone, and posterior teeth. The study included 1,140 study units from 570 patients visualized with CBCT. MS abnormalities, MS septal walls, the anatomical relationship between the MS and the teeth, and missing teeth were recorded. Adjacent odontogenic infections, including periapical lesions, periodontal bone loss, and combined periodontal-endodontic lesions, were documented, and the shortest distance between the infection and the MS floor was measured. The possible correlations between odontogenic conditions and MS abnormalities were analyzed. Whether the anatomical relationship between the MS and the teeth was related to age or sex was analyzed. The chi-squared test, Fisher's exact test, Mann-Whitney U test, Kruskal-Wallis H test, and logistic regression were used for the statistical analyses. MS abnormalities were detected in 57.54% of patients and 42.89% of MSs. Male sex (OR =1.653; P<0.001) and a MS adjacent to teeth with periapical lesions (OR =5.771; P<0.001), periodontal bone loss (OR =2.778; P<0.001), or combined periodontal-endodontic lesions (OR =13.818; P<0.001) increased the probability of MS abnormalities. In MSs with a single infected tooth, male sex (OR =2.413; P=0.045), infected molar (OR =3.431; P=0.008), and a smaller distance between the infection and the MS floor (OR =0.871; P=0.021) increased the probability of MS abnormality. The maxillary root apices of older subjects tended to be farther from the MS (P<0.001). Adjacent odontogenic infection increased the probability of MS abnormalities. The likelihood of MS abnormality was related to the distance between the infection and the MS, not to the type of infection.

What ultimately matters in root canal treatment success and tooth preservation: A 25-year cohort study.

There are currently no prospective studies evaluating the long-term outcomes of non-surgical root canal treatments beyond 5 years, both in terms of treatment success and tooth preservation, and identifying factors predictive of treatment outcome. The aim of the present work was therefore to fill this gap by assessing these outcomes over time and identifying predictive variables based on systematic data collection over a 25-year period. Data concerning the treatments (N= 2500) were systematically collected since 1990. Information was recorded among clinical, technical, radiographic and patient-related characteristics, i.e., approximately 150 variables for each treatment. The data were analysed regarding both treatment success and tooth preservation by multivariable Cox proportional hazards model, and survival curves were generated. The statistical significance level was set at 0.0125. In total, 56.4% of the treatments could be followed over time (0-25 years, mean=6.5 years, median=5 years). Survival probability decreased almost linearly for treatment success, with about 85% after 5 years and 60% after 20 years, and for tooth preservation, with about 90% at 5 years and 50% at 20 years. The variables significantly associated with treatment failure were: pre-operative pain (Hazard Ratio-HR=1.56 [95% CI 1.23-1.97]), persistent pain (HR=2.63 [95% CI 1.44-4.80]), good operator rating of treatment prognosis (HR=0.46 [95% CI 0.36-0.58]), size of periapical bone radiolucency (HR=1.88 [95% CI 1.67-2.11]), and tooth type (p=.0006). For tooth extraction, they were: combined endodontic-periodontal lesion (HR=3.37 [95% CI 1.88-6.05]), pre-existing complication before treatment (HR=1.67 [95% CI 1.26-2.21]), good operator rating of treatment prognosis (HR=0.45 [95% CI 0.33-0.60]), clinical failure of root canal treatment (HR=2.78 [95% CI 1.98-3.89]) and tooth type (p= .0012). Root canal treatment success and tooth preservation on the arch are not static outcomes, but evolve with time. Among a substantial set of potential predictors, only a small proportion was significantly predictive of treatment success and tooth preservation, most of them being disease and patient characteristics, and not technical aspects, except pre-existing complications. These observations challenge the importance frequently given to byzantine considerations related to the numerous technical details of endodontic procedures, as opposed to general concepts of good clinical practice.

Interdisciplinary management of combined periodontal-endodontic lesions with palatogingival grooves of the maxillary lateral incisors: a case report.

A palatogingival groove of the maxillary lateral incisor is an anatomic malformation, which always predisposes the tooth to pulpal and periodontal disease. The diagnosis and treatment planning become complicated, with uncertain prognosis. Herein, we present an effective interdisciplinary management of a case of combined periodontal-endodontic lesions caused by palatogingival grooves. A series of treatment modalities were undertaken to preserve the two teeth, including root canal treatment, periodontal initial therapy, splinting the mobile teeth, occlusal adjustment, apical microsurgery, grinding and sealing grooves, and guided tissue regeneration. An apparent healing of the lesions was visible after 12 months. Therefore, interdisciplinary management of combined periodontal-endodontic lesions with palatogingival grooves of the maxillary lateral incisors is necessary for a favourable long-term outcome.

Prevalence of true combined endodontic-periodontal lesions in adult patients with and without diabetes: A cross sectional survey

Prevalence of true combined endodontic-periodontal lesions in adult patients with and without diabetes: A cross sectional survey

Time-lapse between periodontal regeneration surgery and root canal therapy in sever combined periodontal-endodontic lesions

ObjectiveThe purpose of this study was to evaluate the time-lapse of periodontal regeneration surgery of combined periodontal-endodontic lesions (PEL) after root canal therapy (RCT) to guide the clinical treatment. Methods26 patients (28 teeth) with severe combined PEL were equally divided into 4 groups (n = 7); the control group included patients who underwent periodontal regeneration surgery with no prior RCT and the remaining three experimental groups including patients who received periodontal regeneration surgery post-RCT either immediately or after 3 and 6 months. The probing depth, clinical attachment loss, and periodontal bone density were measured before or after 3, 6, and 12 months post-RCT, respectively. ResultsPeriodontal regeneration surgery could improve the PD (Probing Depth), CAL (Clinical Attachment Loss), BD (Bone Mineral Density) values irrespective of whether the RCT was performed within 12 months or not. However, obviously improved PD, CAL and BD were observed when surgery was performed post-RCT. The time lapse between RCT and periodontal regeneration surgery had no obvious effects on the periodontal index in 3 months after the surgery. Moreover, these periodontal indexes tend to stabilize in 3 to 6 months after the surgery with no significant differences. ConclusionAlthough there were no obvious impacts of time lapse between RCT and periodontal regeneration surgery on the severe PEL, an earlier periodontal surgery might contribute to the healing of periodontal lesions.

Effect of maternal true combined endodontic-periodontal lesion on insulin and inflammatory pathway in adult offspring.

Maternal periodontal disease (PED) and apical periodontitis (AP) are associated insulin resistance (IR), increased tumor necrosis factor-α (TNF-α) levels, and alterations in insulin signaling (IS) in the gastrocnemius muscle (GM) of adult offspring. TNF-α stimulates I kappa B kinase (IKK) and c-Jun N-terminal protein kinase (JNK), resulting in IS attenuation. However, studies that investigated the maternal true endodontic-periodontal lesion (EPL) in offspring are scarce, and in this case, the impact could be even higher. This study aimed to evaluate the effects of EPL on the IR, IS, and inflammatory pathways on the offspring GM. Female Wistar rats were distributed into control, AP, PED, and EPL groups. After 30 days of oral inflammation induction, rats from all groups were allowed to mate with healthy rats. The body weight of the offspring was assessed from birth to 75days of age. After 75days, the following measurements were performed: glycemia, insulinemia, IR, TNF-α content, and IKKα/β, JNK, pp185 (Tyr), and IRS-1 (Ser) phosphorylation status in the GM. Maternal PED and EPL were associated with low birth weights. All maternal oral inflammations promoted IR and IS impairment in the GM and only maternal PED and EPL caused an increase in TNF-α content and IKKα/β phosphorylation status in the GM of offspring. The offspring of the rats with EPL group showed worsening of metabolic changes when compared with offspring of rats with AP or PED. Association of maternal AP and PED promoted a more pronounced worsening in the health of the adult offspring.

Prevalence of endo-perio lesions according to the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Disease in a university hospital.

Teeth with combined endodontic-periodontal lesions (EPLs) have favorable to hopeless prognoses. The new classification system was developed by the World Workshop on the Classification of Periodontal and Peri-Implant Disease in 2017 and suitable epidemiologic data related to this new system are currently lacking. This study aims to contribute data about the prevalence of EPLs according to the new system. A total of 1,008 panoramic views taken in 2019 were analyzed, recording the presence of an EPL and other periodontic parameters. Radiographs of bad quality and of the same person were excluded. Additionally, the EPLs' radiographic patterns were rated by two raters according to their shape (j-shaped vs cone-shaped). Descriptive statistical methods as well as t tests for continuous and chi-squared tests for categorical variables were used. Overall, 866 patients (with 18,963 teeth) were included. Prevalence of EPLs was 4.9% (n = 43) (patient-related)/0.4% (n = 71) (tooth-related). Mean age (62.3 years vs 51.5 years), mean maximal percentage of bone loss (60% vs 30%), and mean age-adjusted bone-loss index (1.0 vs 0.6) were considerably higher compared to patients without EPL. A total of 67 EPLs were found in patients with stage III/IV periodontitis and 4 in patients with stage II periodontitis. This is the first study showing prevalence of EPLs (4.9%/0.4%) according to the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Disease. Patients with EPLs have a substantially higher maximal percentage of bone loss and a higher age-adjusted bone-loss index at residual teeth, excluding teeth with EPLs. All patients have at least stage II periodontitis.

True-Combined Endodontic - Periodontal Lesion: A Sequential Endodontic Treatment

A combined endodontic-periodontal lesion is characterized by the association of endodontic and periodontal infection in the same tooth, attacking and destroying its attachment system. This complicates the therapeutic management because the simultaneous control of the two infections would be inconvenient in clinical practice. It would therefore be essential to sequence the stages of both periodontal and endodontic treatment. The general objective of this article would be to shed light on the contribution of the endodontic approach in the treatment of combined endodontic-periodontal lesions and to specifically underline its influence on the prognosis of this condition.

Cemental tear: Literature review, proposed classification and recommendations for treatment.

Cemental tears are an important condition of relevance to Endodontics but are often overlooked. A cemental tear is the partial or complete detachment of the cementum from the cemento-dentinal junction or along the incremental line within the body of cementum. The limited attention received is most likely due to the limited awareness amongst dental professionals and challenges in accurately diagnosing them, resulting in misdiagnosis and erroneous treatment. The aim of this review is to describe the: (i) epidemiology and predisposing factors; (ii) clinical, radiographic and histological features and (iii) the clinical management and treatment outcomes of cemental tear. The review included 37 articles published in English that comprised eight observational studies and 29 case reports. The prevalence of cemental tears was reported to be lower than 2%; whilst the incidence remains unknown. Internal factors due to the inherent structural weakness of cementum and its interface with the dentine, and external factors that are associated with stress have been proposed as the two mechanisms responsible for the development and propagation of cemental tears. Predisposing factors that have been implicated were tooth type, gender, age, previous root canal treatment, history of dental trauma, occlusal trauma and excessive occlusal force; however, evidence is limited. Common clinical and radiographic manifestations of cemental tears resemble the presentations of primary endodontic diseases, primary periodontal diseases and combined endodontic-periodontal lesions. Clinical management tended to focus on complete removal of the torn fragments and periodontal treatment, often combined with regenerative treatment. In this article, a new classification for cemental tears is developed that consists of classes 0 to 6 and stages A, B, C and D based on the: (i) location and accessibility of the torn cemental fragment; (ii) the pattern and extension of the associated bony defect in relation to the root length and (iii) the number of root surface/s affected by the cemental tear/s and the associated bony defect. Recommendations for treatment strategies are also provided and linked to the classification to aid in streamlining the process of treatment decision making.

Cone Beam Computed Tomography Study on the Incidence of Endodontic Filling Biomaterials Resorption in Patients With/Without Orthodontic Treatment

Abstract Background: The differential diagnosis of endodontic and periodontal diseases can sometimes be clinically difficult, but it is vital to establish a correct diagnosis so that predictable treatment can be offered. Aim: The aim of this study was to highlight the prevalence of endo-periodontal lesions in the frontal dental group of the lower jaw depending on the degree of bone resorption as well as endodontic filling resorption in different patients, some of them with orthodontic treatment, using conical beam computed tomography (CBCT). Materials and methods: A number of 31 CBCT imaging volumes and the medical records of these patients were selected for analysis by an experienced examiner. The sites selected for analysis were divided into two subgroups, one where the endodontic treatment was performed with Endomethasone™ (Colthene, Creteil, France) (7 patients), and the other where it was performed with Adseal™ (Meta Biomed, Seoul, South Korea) (6 patients). Results: The mean age of the study population was 24.1 years, and 35.8% presented previous orthodontic treatment in their medical history. There were no statistically significant differences (p = 0.54) between groups regarding the length of the endodontic filling, the Endomethasone group showing a total length of 11.24 millimeters while the Adseal group showed a total length of 10.85 millimeters. Conclusions: The image obtained in clinical situations in which patients present combined endodontic-periodontal lesions is of real help because in many cases, with the help of CBCT, the starting point of a combined lesion can be highlighted, whether it is endodontic or periodontal.

Endo-perio lesions prevalence in non-molar and molar teeth: a pilot study

Abstract Introduction Pulp and periodontal tissues may communicate and, in pathological situations, combined endodontic-periodontal lesions may be established. Objective The aim of this study was to evaluate the prevalence of endo-perio lesions in non-molar and molar teeth referred for endodontic treatment. Material and method The sample consisted of 104 teeth evaluated in 79 consecutive patients in a cross-sectional design. Visible plaque, probing depth, and bleeding on probing were evaluated. Endodontic evaluation included the presence or absence of caries, fistulas, pain, and pulp sensitivity. The presence/absence of periapical lesion, bone loss in the furcation region, and proximal area were evaluated. Result The results showed that pain was the main reason for seeking dental care in 63.3% of patients. The molar teeth demonstrated higher presence of probing depth (PD) ≥ 7 mm (38.3%) and higher PD mean (6.17 mm) than non-molar teeth (P&lt;0.05). It was verified that 65.4% of the teeth were diagnosed with a primary endodontic lesion and that the periodontal component was present in 34.6% of the teeth, either in a primary (10.6%), secondary (11.5%), or combined form (12.5%). True combined endodontic-periodontal lesion occurred significantly in molar teeth compared to non-molar teeth (p&lt;0.05). Conclusion The primary endodontic lesion was found in a greater proportion in teeth referred for endodontic treatment; however, approximately 1/3 of the sample had periodontal involvement, which demonstrates the importance of the periodontal examination together with the general clinical examination.

Effect of autologous platelet aggregates on the healing outcome of periapical surgery for the management of apico-marginal defects: A systematic review

Introduction: An apico-marginal defect is a combined endodontic periodontal lesion that poses a challenge to the healing outcome and therefore often leads to the decreased prognosis of periapical surgery. This systematic review aims to analyze clinical studies and case reports that show evidence of the effect of autologous platelet aggregates on the healing outcome of apico-marginal defects. Materials and Methods: Literature search strategy was performed to find relevant clinical studies and case reports according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. The question was “healing outcome of apico-marginal defects treated using autologous platelet aggregates.” The review involved a search of electronic databases of Pubmed, Scopus, Ebsco host, as well as manual search. Results: Five relevant literature published between 1990 and June 2019 were selected after thorough analysis and exclusion according to the strict criteria. The included studies were related to clinical and radiographic healing outcome of apico-marginal defects with autologous platelet aggregates. Conclusion: The collected data suggested that autologous platelet aggregates give a favorable healing outcome for the management of apico-marginal defects.

The significance of periodontal ligaments on the diagnosis and treatment modality for combined periodontal-endodontic lesions

The significance of periodontal ligaments on the diagnosis and treatment modality for combined periodontal-endodontic lesions

Intentional Replantation with a 2-segment Restoration Method to Treat Severe Palatogingival Grooves in the Maxillary Lateral Incisor: A Report of 3 Cases

The palatogingival groove is a developmental anomaly that typically starts near the cingulum of the maxillary incisors and extends along the roots at varying lengths and depths. Severe grooves that extend to the root apex often lead to complex combined periodontal-endodontic lesions. There are various therapeutic options available for these cases; however, the prognosis is unfavorable. Here, we report the successful surgical treatment of 3 cases of maxillary lateral incisors with severe palatogingival grooves using intentional replantation with a 2-segment restoration method. The teeth were gently extracted, resulting in minimal damage to the periodontal ligament. Under a dental operating microscope, 3 mm of the root end was resected. The palatogingival groove was removed, and root-end preparation was performed with a #700 fissure bur. The groove cavity was connected with root-end cavity to form a class II cavity. The cavity was then filled using a 2-segment restoration method (ie, dividing the cavity into 2 parts by the cementoenamel junction, the coronal portion was filled with a flowable composite while the radicular portion, including the root-end cavity, was filled with bioceramics). The tooth was then replanted into its alveolar bone and splinted with a flexible splint for 7 days. The sinus tract was closed at the 1-week postoperative visit. During subsequent recalls, the teeth showed almost complete periapical healing. In summary, intentional replantation with a 2-segment restoration method is a viable treatment modality for single-rooted teeth with a severe palatogingival groove that extends to the root apex.

Combined endodontic-surgical management of a palato-gingival groove in a maxillary lateral incisor with two canals

Abstract: Maxillary lateral incisors often exhibit embryological variations and developmental anomalies. The palato-gingival groove (PGG) is a rare anomaly that can pose difficulties in accurate diagnosis and treatment planning. Its presence can predispose to localized periodontal involvement, pulpal necrosis and combined periodontal-endodontic lesions. This case report describes the combined endodontic and surgical management of a complex type of palato-gingival groove in a maxillary right lateral incisor with two canals which was diagnosed with the help of cone beam computed tomography (CBCT) and successfully managed using advanced bioactive materials. CPD/Clinical Relevance: Clinicians should be familiar with the diagnosis and treatment planning in cases with a palato-gingival groove. Complex cases require combined endodontic and periodontal therapy. Autologous platelet rich fibrin (PRF) is a simple and cost-effective healing aid which helps in the regeneration of attachment apparatus.

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.