Endo-perio Lesion Research Articles

A Comparative Study of Platelet-Rich Fibrin (PRF) and Titanium-Prepared Platelet-Rich Fibrin (T-PRF) in Management of Endo-Perio Lesion

ABSTRACT Introduction: Association between pulp and periodontal lesion is termed as endo-perio lesion. Treatment of intra-bony defect can be done by GTR. Methodology: The present study was conducted on 180 patients suffering from endo-perio lesion. They were divided into two groups namely the ones treated by PRF and the other one treated with T-PRF. Follow-up was taken at 3 and 6 months interval. The results thus obtained were analyzed statistically using SPSS version 21.0 (IBM. Chicago, USA) and unpaired t test. The level of implication was set less than 0.05. Results: Mean change in probing depth at period of 3 months in group 1 is 2-15 while after 6 months is 2.74. P value is 0.91 which is highly insignificant. Similarly relative attachment level at 3 months is 1.96 and at 6 months is 2.63. P value is 0.73. Conclusion: No statistically significant results were observed in term of baseline attachment measurements.

Successful management of endo-perio lesions (EPL)

Successful management of endo-perio lesions (EPL)

Assessment of Risk Factors and Prognostic Predictors for Endo-Perio Lesions in Indian Cohorts: An Observational Study.

Endodontic and periodontal tissues exhibit a significant interrelationship, whereby pathologies affecting one tissue can precipitate the involvement of the other. The primary objective of this study was to assess the risk factors associated with endo-perio lesions (EPLs). The secondary objective was to assess the prognostic predictors for such lesions and the prevalence rate of EPLs involving both pulpal and periodontal tissues in Indian cohorts. A prospective observational study was conducted on 2170 teeth with EPLs in Indian adults aged > 18 years. A detailed history of smoking, tobacco chewing, and the development of EPLs was obtained from all patients. Detailed periodontal and endodontic examinations were conducted by two calibrated examiners. Intraoral periapical radiographs (IOPAs) were obtained to diagnose EPLs. The chi-square test of association was used to analyze the association between independent and dependent variables, and the strength of association was presented by Pearsoncontingency coefficient (r). Logistic regression analysis was performed to identify reliable factors for diagnosing EPLs. A statistical significance threshold of 0.05 was established. The prevalence of EPLs involving pulpal and periodontal tissues was 29.49%. Type 1 lesions (EPLs involving only pulpal tissue) were most commonly seen at 41-45 years of age, type 2 lesions (EPLs involving primary pulpal and secondary periodontal tissue), and type 3 lesions (EPLs involving only periodontal tissue) at 26-30 years of age, and type 4 lesions (EPLs involving primary periodontal and secondary pulpal tissue) at 31-35 years of age. The pulp was found to be non-vital in all cases of type 3 lesions, and faulty restoration or improper root canal treatment (RCT) was the main risk factor for such lesions. Occupational trauma was found to be the most common risk factor for type 3 and type 4 lesions. Smoking, age, tooth type, occlusal trauma, faulty restorations and RCT, presence of caries, periapical pathology, periodontitis, bone loss, and pulp vitality were significantly associated with EPLs. Pulp vitality and bone loss were two prognostic predictors of EPLs.

Assessing the Information Quality, Accuracy and Content of YouTube Videos on the Endo-Perio Lesions: A Cross-Sectional Stud

Assessing the Information Quality, Accuracy and Content of YouTube Videos on the Endo-Perio Lesions: A Cross-Sectional Stud

A clinical approach in the management of endodontic-periodontal lesions of endodontic origin: Two case reports with 2-year follow-up

Abstract The term “endodontic-periodontal” (endo-perio) lesions describe lesions with the involvement of pulpal tissues and the periodontium of a tooth. These cases regarding the diagnosis, management, and prognosis of teeth are challenging for the clinician. The aim of this article was to discuss two cases of endo-perio lesions in molars with large periapical radiolucencies. Two healthy male individuals came with a chief complaint of pain during chewing. During clinical examination, a deep periodontal pocket of 10 mm and 7 mm, respectively, was noticed in both cases, and large periapical radiolucencies extended to the apical region were confirmed by the intraoral periapical radiographs. Evaluation of the symptoms together with the clinical findings determined the diagnosis endo-perio lesion of endodontic origin and accordingly the decision for the management. The successful treatment outcome with the periodontal healing in both cases was observed soon 40 days after orthograde root canal treatment. Conservative endodontic therapy was the key to the healing of the periapical tissues in endo-perio lesions of endodontic origin. The clinical approach as well as the 2-year follow-up of those compromised endo-perio lesions showed that endodontic therapy resulted in the healing, whereas no periodontal therapy was performed and the initial decision-making was confirmed.

Endodontic surgery and platelet concentrates: A comprehensive review.

While autologous platelet concentrates (APCs) have gained traction as promising regenerative materials in recent years, their impact on wound healing and tissue regeneration in periapical hard tissue defects remains controversial. Endodontic microsurgery (EMS) has embraced the potential of platelet concentrates, particularly L-PRF (Leucocyte-Platelet-Rich Fibrin) and PRP (Platelet-Rich Plasma), as regenerative tools. These concentrates, rich in growth factors and other bioactive molecules, are thought to enhance healing and treatment outcomes for various endodontic conditions. However, their effectiveness remains a subject of investigation. Despite encouraging 3-D cone beam computed tomography (CBCT) based evidence for PRP's effectiveness in complex lesions and apico-marginal defects, inconsistencies in its performance across preparation and application protocols raise questions about its superiority over existing options. More research is crucial to understand its full potential as a reliable regenerative tool in endodontics. L-PRF and its derivatives are particularly effective in treating apical-marginal defects. It enhances clinical attachment levels and reduces probing pocket depths, likely due to its slow and coordinated release of various growth factors. L-PRF has been shown to also improve patients' quality of life by reducing postoperative swelling and pain. However, more research is needed to standardize its preparation methods and confirm its long-term benefits. This paper aims to provide a comprehensive review of the current knowledge and recent advances in endodontic surgery and the use of platelet concentrates, focusing on their roles in managing periapical lesions and endo-perio lesions.

Non-Surgical Management of Endo Perio Lesion- A Case Report

Endodontic-periodontal lesions, which stem primarily from issues with the dental pulp and secondarily from problems with the gingiva, are frequently encountered in dental practice. It emphasizes the importance of integrating both endodontic and periodontal treatments to effectively address these complex cases. Correct diagnosis in endodontics, based on a thorough dental history, clinical examination, and radiographic evaluation, is pivotal in determining the prognosis and formulating an effective treatment plan for endodontic-periodontal lesions. This case report enlighten the management of a case of endo – perio lesion.

Clinicial-pathologic correlations of non-trauma related Odontodysplasia in 28 dogs: 2013-2023.

Odontodysplasia is an uncommon dental developmental disorder associated with enamel, dentin, pulp abnormalities, and overall tooth morphology. The affected tooth is grossly abnormal in size and contour and is commonly associated with swelling of the affected area and failure of eruption. Histologically, the enamel and dentin are hypoplastic and hypomineralized. Odontodyplasia occurs most commonly in response to direct trauma to the developing tooth bud (enamel organ and dental follicle). Data on the prevalence and features of non-traumatic odontodysplasia are lacking. Medical records of dogs diagnosed with odontodysplasia were reviewed at the William R. Pritchard Veterinary Medical Teaching Hospital (VMTH), University of California, Davis, for 10 years (from 2013 to 2023). Dogs with a known history of facial trauma, persistent deciduous tooth or teeth over the region of odontodysplastic tooth or teeth, and endodontic disease of the persistent deciduous tooth or teeth were excluded from the study. Twenty-eight dogs were included in this retrospective study, representing an incidence of 1.4 per 100 dogs presenting over 10 years. Regional odontodysplasia (RO) was identified in twenty-two dogs, and generalized odontodysplasia (GO) was found in six dogs. Both comprehensive oral examination and diagnostic imaging were essential in diagnosing and assessing the presence of odontodysplasia. Awake oral examination failed to identify odontodysplasia in almost 70% of the RO cases. Secondary diseases or lesions in odontodysplastic teeth, such as periodontal disease, endodontal disease, and perio-endo lesions, were commonly seen and were particularly more frequently identified in strategic teeth (canine and carnassial teeth) than non-strategic ones. Similarities, such as female predilection, maxilla more commonly affected, and clinical signs, were observed between RO in dogs and those reported in people. The exact etiology of non-traumatic odontodysplasia remains elusive, and the condition may be of multifactorial causality.

A report on the impact of CGF on hard and soft tissues around endo-perio lesion.

There is an increased chance of further periodontal deterioration due to severe intrabony defect. There are s different patho physiologies for perio-endo lesions, ranging from quite basic to rather complicated but to make the right diagnosis, one must be aware of various illness processes also a careful history taking, examination, and the application of specialized tests can help achieve this. Each form of endodontic-periodontal illness has a different prognosis and course of therapy and all kinds of endo-perio lesions require endodontic and periodontal treatments are necessary for primary periodontal disease with subsequent endodontic involvement and real mixed endodontic-periodontal disorders. The severity of the periodontal disease and how well the patient responds to therapy will determine how these situations turn out. Because autologous platelet concentrates are enriched with growth factors, such as concentrated growth factor (CGF), they may enhance surgical outcomes. CGF is inserted into the appropriate intrabony defect following traditional flap debridement. Following flap surgery, the tooth in question had a root canal operation. Volumetric analysis was performed on both groups before to surgery and nine months after the procedure. It has been discovered that the defect area has a much larger bone volume due to the high levels of CGF, a regenerative and reconstructive growth factor that promotes early and high bone fill.

Linking periodontal pathogens with endoperio lesions.

Endodontic-periodontal diseases pose difficulties for the practitioner in diagnosing and predicting the success of the affected teeth. Therefore, it is of interest to correlate between periodontal infections and endodontic periodontal disorders. 50 patients of both sexes were included in this study. 28 of the 50 patients were men and 22 were women. Participants with a history of endodontic and periodontal lesions on the same tooth were chosen. A polymerase chain reaction experiment was carried out and relationships were formed. Data shows that isolates of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans and Tannerella forsythia were identified in 91% of the periodontium, 12% of the endodontium, and 51% of the endodontium, respectively. Targeted bacterial species were associated with periodontal and endodontic disorders that occurred concurrently. Therefore, it is plausible to speculate that dentinal tubules serve as a channel for the dissemination of microorganisms.

Exploring the Interface: A Case Series on Endoperio Lesions.

Endoperiodontal lesion is a result of pathological/inflammatory connections between pulpal and periodontal tissues via open structures like apical foramina, dentinal tubules, and lateral accessory canals. This case series deals with endoperio lesions in which regenerative treatment is performed post-root canal treatment (RCT). Post 6 months, results suggested uneventful healing with gain in clinical attachment level.

Management of Endo-Perio lesion in a Tooth with an Unfavorable Prognosis: a Clinical Case Report with an 18-Month Follow-Up

The aim of this case study is to report a successful clinical case of an endo-perio lesion in a tooth with an initially unfavorable prognosis, followed up for 18 months. A male patient, public servant, non-smoker, without a history of diabetes, and married sought dental treatment in 1995 due to periodontal problems. He was then 40 years old and diagnosed with moderate to advanced periodontal disease. The initial treatment consisted of supra and subgingival scaling, followed by the extraction of teeth indicated for removal. After discharge, the patient adhered to a preventive periodic maintenance (PPM) program to control periodontal disease recurrence. In 2021, tooth 43 showed an unfavorable endo-perio lesion during a routine check-up. Despite treatment options, the patient opted for conservative treatment with endodontic and periodontal procedures. Simultaneously, PPM sessions were performed. The patient was monitored every six months, showing regression of periodontal pockets and significant improvement after 18 months. This case highlights the importance of patient adherence to PPM, demonstrating that a conservative approach and proper maintenance can lead to positive clinical outcomes even in cases with an initially unfavorable prognosis.

Endo-Perio Lesions and Dentists' Treatment Approach: A Survey.

BACKGROUND Endo-perio lesions are a great challenge for dentists. The aim of this study was to evaluate the treatment approach of dental practitioners to endo-perio lesions by considering the current endo-perio classification. MATERIAL AND METHODS An online survey was prepared, consisting of questions about the treatment approach to 3 simulated cases with endo-perio lesions, shown on periapical radiography. Details of the patient's age, presence of systemic disease, smoking, and how the single- or multi-rooted tooth would affect the treatment plan were also included in the simulated cases presented in the survey. The survey was sent to 1500 dentists via e-mail, WhatsApp, and social media platforms. The chi-square test was used for comparison of data. Significance was evaluated at P<0.05. RESULTS In total, 338 dentists participated in the survey, including general dentists, endodontists, and periodontists. Fifty-three percent of participants stated that they would perform root canal treatment and initial periodontal treatment simultaneously, when both treatments were required. In cases classified as grade 3, most general dentists, endodontists, and periodontists answered that they would prescribe systemic antibiotics if there was diffuse extra-oral swelling (P<0.05). Moreover, in grade 3 cases, more general dentists chose the option "extraction" as the best choice, compared with endodontists and periodontists, who did not choose extraction as often (P<0.05). CONCLUSIONS According to the results of this study, general dentists, endodontists, and periodontists generally follow different approaches to endo-perio lesions. A consensus is needed on this issue to develop a successful multidisciplinary approach to endo-perio lesions.

A retrospective study on the prognostic factors and success, survival, and failure outcomes of treated endodontic-periodontal lesions.

The objective of this retrospective study was to determine possible prognostic factors of endodontic-periodontal lesions and to compare success, survival, and failure outcomes of treated endodontic-periodontal lesions across different treatment modalities, demographic variables, and anatomical tooth variations. Data was collected from patient records in the patient management system (Salud, Titanium Solutions) from the Griffith University Dental Clinic between January 2008 and December 2021. The search strategy used the terms "endodontic periodontal lesion," "periodontal endodontic lesion," "endo perio lesion," "perio endo lesion," and "EPL." The 88 cases which met inclusion and exclusion criteria were analyzed. The overall success rate was 46.6%, with 21.6% of teeth surviving and 31.8% of teeth failing. Bone loss extending to the apical third (OR = 0.3, 95% CI [0.104, 0.866]), and probing depths of 5-7 mm (OR = 0.147, 95% CI [0.034, 0.633]) and 8-10 mm (OR = 0.126, 95% CI [0.029, 0.542]) were associated with a statistically significant lower odds of success (p < .05). A history of no periodontal disease (OR = 7.705, 95% CI [1.603, 37.037]) was associated with a statistically significant higher odds of success (p < .05). Practitioners should be aware of bone loss to the apical third, deep probing depths, and a history of periodontal disease as possible prognostic factors that can affect the success rate when treating endodontic-periodontal lesions. Further research with more stringent control over operator factors should be done to investigate these variables.

Comparative Evaluation of Microbial Flora of Endodontic Origin in Teeth with Endo-Perio Lesions

ABSTRACT Background: Endodontic microbial flora plays a pivotal role in the development and persistence of periodontal endodontic lesions (PELs). Understanding the composition and prevalence of microbial species in PELs is essential for effective treatment strategies Materials and Methods: Microbial samples were collected from 50 teeth diagnosed with PELs. Sterile paper points were used to obtain samples from the root canals. Deoxyribonucleic acid (DNA) was extracted and subjected to polymerase chain reaction (PCR) amplification of the 16S ribosomal RNA (rRNA) gene to identify bacterial species. The obtained data were analyzed using statistical methods. Results: The microbial analysis revealed a diverse range of bacterial species in PELs. The most prevalent species were Porphyromonas gingivalis (32.5%), Treponema denticola (28.0%), and Fusobacterium nucleatum (22.5%). Streptococcus mutans (9.0%) and Actinomyces naeslundii (8.0%) were also frequently detected. Additionally, Prevotella intermedia (7.0%), Aggregatibacter actinomycetemcomitans (3.5%), and Enterococcus faecalis (2.5%) were present in lower frequencies Conclusion: The presence of a diverse microbial flora in teeth with PELs underscores the polymicrobial nature of these lesions. The predominance of periodontal pathogens such as Porphyromonas gingivalis, Treponema denticola, and Fusobacterium nucleatum suggests a strong association between periodontal and endodontic infections. A comprehensive understanding of the microbial profile in PELs is crucial for tailored therapeutic approaches targeting the specific pathogens involved.

Treatment of periodontal abscess

ABSTRACT A periodontal abscess is a localized, purulent infection involving a greater dimension of the gum tissue, extending apically and adjacent to a periodontal pocket. Representing 6%–14% of all dental emergencies, the third-most common dental emergency is the periodontal abscess. Classification of periodontal abscesses depends on their course, location, number, and etiological criteria. The etiology of the periodontal abscess has been directly associated with periodontitis or sites without the previous existence of periodontitis. The presence of local and systemic factors makes the patient vulnerable to a periodontal abscess. It has been reported that microorganisms, primarily Gram-negative anaerobic rods, colonize the periodontal abscess. The usual clinical features of the periodontal abscess are the presence of generalized periodontal disease with pocket and bone loss, commonly related to the vital tooth, swollen and tender, sinus opening, or pus discharge through the periodontal pocket. The periodontal abscess should be ruled out from similar conditions and lesions as periapical abscess, gingival abscess, endo-perio lesion, perio-endo lesion, root fracture, and cracked tooth syndrome. The periodontal abscess diagnosis is based on the chief complaint and the history of the present illness, clinical findings, and investigations. Periodontal abscess management is a combination of three stages: immediate management, initial management, and definitive therapy. Early diagnosis and immediate treatment are crucially important for periodontal abscess management, to prevent the loss of an involved tooth. In this case report, all aspects of the periodontal abscess are described.

Management of endo-perio lesion with autologous stem cell therapy

The objective of periodontal therapy is the regeneration of tooth-supporting tissues. Various treatment modalities, such as the use of bone grafting materials, guided tissue regeneration, and delivery of enamel matrix derivatives or growth factors, are applied with large variability in regenerative outcomes. However, a case report was done by utilization of autologous dental pulp stem cells and periodontal ligament stem cell niches in the treatment of bone loss associated with endodontically and periodontally involved teeth. An autologous periodontal ligament stem cells niche adherent to the root and dental pulpal stem cells from dental pulp directly into the selected osseous defect following extraction of the impacted tooth in the same patient. The results of this case reported that the dental pulpal stem cells and periodontal ligament stem cells niche with gelatin sponge resulted in a significant amount of bone fill and reduction in probing pocket depth.

Clinically E Clinically Effective Regener e Regenerative Therapy for Primar y for Primary Endodontic y Endodontic Lesions with Secondary Periodontal Lesions: A Case Report

The diagnosis and prognosis of teeth with endo-perio lesions present a major challenge for dentists. Proper diagnosis is critical in determining treatment and the long-term prognosis. However, treating complex endodontic and periodontal lesions is one of the most common challenges in current clinical practice. The coexistence of pulpal and periodontal tissue damage may complicate diagnosis and further influence dental prognosis. This article consists of a case report evaluating the efficacy of xenografts and resorbable membrane pericardium in treating bifurcation lesions associated with periodontal lesions of the left mandibular first molar. A 22-year-old female patient was referred by conservative dentistry with complaints of gingival swelling on tooth 36 with furcation involvement associated with periodontal lesions. A gingivectomy was performed after the first stage of periodontal therapy because gingival swelling precluded endodontic treatment. After 3 months of endodontic treatment, the grade II bifurcated lesion had not yet healed, so regenerative surgery using xenografts and a resorbable pericardial membrane was performed. Periodontal treatment showed no gingival inflammation, and radiographic evidence showed bone improvement. Endo-perio lesions are complex in etiology and require a high degree of expertise to identify and treat them. Therefore, effective treatment of lesions requires collaboration between various multidisciplinary disciplines.

Awareness and knowledge of endo-perio lesions among fifth year students and interns at King Saud Dental College: a questionnaire-based study

Background: This study aims to assess the diagnostic knowledge and understanding of endo-perio lesions among senior dental students and interns enrolled at King Saud College of Dentistry. Methods: A cross-sectional questionnaire-based study was conducted using Google Forms. The questionnaire included two radiographic case images and assessed participants' experience with endo-perio lesions, confidence in diagnosis, and familiarity with treatment approaches. The study included 200 participants, consisting of 140 interns and 60 5th-year students. Results: The majority of participants (61%) reported encountering endo-perio lesions in their clinics. Among the participants, 50% expressed confidence in diagnosing these lesions. Intern students demonstrated higher knowledge and awareness of endo-perio lesions compared to 5th-year students. Statistically significant differences were observed in the awareness of endo-perio lesions and confidence in diagnosis between the two groups. However, both groups showed room for improvement in their diagnostic and treatment capabilities. Conclusions: The findings indicate a need for enhanced education and training in this area, particularly for 5th-year students. Incorporating comprehensive theoretical education, clinical case management, and continuing education courses may help improve students' diagnostic skills and treatment outcomes for endo-perio lesions.

Evaluation of Endo Perio Lesions Using Cone Beam Computed Tomography (CBCT) - A Cross Sectional Study.

An accurate assessment of the disease extent and lesion size is needed for appropriate therapy decisions of endodontic-periodontic (endo-perio) lesions. CBCT imaging with less radiation and high spatial resolution can provide a comprehensive evaluation of endo-perio lesions. A total of 71 teeth with endo-perio lesions were assessed using CBCT. Periodontal bone defects were studied for bone loss pattern (horizontal/vertical) along with bone loss levels on mesial and distal sides in association with furcation involvement. The periapical lesions were studied for their prevalence and extent based on CBCT PAI Score. Horizontal and vertical bone loss were detected in 54 teeth (76.1%) and 17 teeth (23.95%), respectively. Mean crestal bone loss levels on mesial and distal aspects were 4.80 ± 3.21 mm and 5.74 ± 3.91 mm, respectively. The mean height, width, and depth of furcation defects were 3.19 ± 2.99 mm, 1.94 ± 0.98 mm, and 4.44 ± 1.92 mm, respectively. Periapical lesions were recorded in 55 teeth (77.5%). A CBCT PAI score of 5 was scored in 35 teeth with a mean lesion diameter of 11.3 ± 2.83 mm, while 16 teeth had healthy periapical tissues (scores of 0 and 1). CBCT is a valuable diagnostic tool that can help assess endo-perio lesions by providing morphometric measurements of periodontal bone defects and the extent of associated periapical lesions.