Endo-periodontal Lesions Research Articles

Assessment of Practitioners' Knowledge of the Diagnostic and Therapeutic Approach to Endo-Periodontal Lesions in Saudi Arabia.

Endodontic-periodontal diseases frequently pose significant challenges for clinicians in terms of diagnosis, management, and prognosis. Practitioners' knowledge of endo-periodontal lesion (EPL) diagnosis is essential for formulating appropriate treatment plans. This study aimed to evaluate the knowledge of diagnostic and therapeutic approaches to EPLs among dental practitioners in Saudi Arabia. The study used a cross-sectional survey among Saudi Arabian dental practitioners using a self-administered questionnaire. The statistical methods used included descriptive analysis, Pearson's chi-square test, Fisher's exact test, and binary logistic regression. Results: The study included 312 respondents, with 95 (30.4%) females and 217 (69.6%) males. The majority were aged 25 to 30 (n = 155, 49.7%). Significant associations were found between participant knowledge and the following variables: age (P < 0.001), organization (P = 0.005), employment (P = 0.001), professional experience (P < 0.001), postgraduate degree (P = 0.002), specialty (P < 0.001), Saudi Commission for Health Specialities (SCHS) rank (P = 0.004), and continuing training (P = 0.043). Additionally, individuals aged 36-40 were 4.3 times more likely to have good knowledge compared to those aged 25-30 (adjusted odds ratio [AOR] = 4.27, P = 0.020), and lecturers were 4.4 times more likely to have good knowledge compared to interns (AOR = 4.40, P = 0.054). This indicates that the practitioners' overall knowledge was above average and that they possess a fundamental understanding of EPLs. These findings have valuable effects on clinical practice, suggesting that evidence-based guidelines and targeted educational programs can enhance the practitioners' diagnostic accuracy and treatment strategies for EPLs, ultimately improving patient outcomes and clinical efficacy.

Assessment of Periodontitis Risk Factors in Endodontically Treated Teeth: A Cross-Sectional Study.

The aim of the study was to collect data about the prevalence and risk factors of apical periodontitis in a population of endodontically treated patients. The study group included 151 patients (52 males, 99 females; mean age 48.36 ± 15.708 yrs.) with 391 endodontically treated teeth (mean follow-up of 5.25 ± 1.759 yrs.). According to the initial tooth diagnosis, root-filled teeth were divided into Group A, root-filled teeth treated for pulpitis or for the purpose of prosthetic pulpectomies (vital pulp group), and Group B, root-filled teeth with non-vital pulp (necrotic pulp). Clinical and radiographic evaluation of the root and its periapical area were performed to establish the success/failure of endodontic therapy, the quality of the root canal fillings (length, density, taper), and coronal restoration. The presence of recurrent caries, periodontal pathology, or endo-periodontal lesions were also recorded. Univariate and multivariate analyses were used to determine the risk factors for apical periodontitis and calculate their odds ratios (ORs). For the root-filled vital pulp tooth group, the highest risks for apical periodontitis are associated with inadequate homogeneity (OR 30.938), periodontitis (OR 9.226), and over-filling (OR 8.800). For the root-filled non-vital pulp tooth group, the highest risks are associated with periodontitis (OR 4.235) and age over 60 yrs. (OR 4.875). For the necrotic pulp tooth group, multivariate analysis identified an age > 60 yrs., filled molars, intracanal posts, poor coronal restoration quality, under-filling, and periodontitis as significant combined risk factors. Inadequate root canal filling and periodontitis in both groups were risk factors associated with most cases of apical periodontitis. Other risk factors include age > 60 yrs., poor coronal restoration quality, and the presence of intracanal posts in root-filled teeth with necrotic pulp.

Prevention of the development of pulp pathology in teeth with endo-periodontal lesions: an in vitro study

Prevention of the development of pulp pathology in teeth with endo-periodontal lesions: an in vitro study

A clinical dilemma: Performing or avoiding root instrumentation in the treatment of the acute phase of endodontic‐periodontal lesions? A case report

AbstractBackgroundThis study presents the diagnois, management, and tissue response to an acute periodontal lesion with deep pocketing affecting a maxillary central incisor in a young patient devoid of caries or a history of periodontitis.MethodsClinical and radiographic examinations facilitated the diagnosis of the pathology as an endoperiodontal lesion (EPL) with root damage, exhibiting supracrestal invasive root resorption. Orthograde endodontic therapy was employed to decontaminate and seal the endodontic space. The resorptive site was treated through the endodontic access, debrided, and sealed. No periodontal therapy (surgical or nonsurgical) was performed. No mechanical instrumentation was performed within the pocketed root surface.ResultsAt 6‐month and 1‐year follow‐ups after endodontic therapy the periodontium displayed a physiologically healthy condition without pus or inflammation, exhibiting a circumferential probing depth of 2 mm, and absence of tooth mobility. These favorable outcomes persisted throughout a 4‐year follow‐up period.ConclusionsThe spontaneous healing of pocketing and abscess occurred without mechanical root instrumentation following endodontic therapy and treatment of external invasive root resorption in an EPL.Key Points Accurate diagnosis and identification of relevant etiologic factors are pivotal for effectively managing endodontic‐periodontal lesions. Once a diagnosis is established, the therapy focuses on eliminating the primary cause, followed by a subsequent diagnostic phase after healing. The definitive understanding of the diagnosis and etiology of endodontic‐periodontal lesions often becomes clear in retrospect, based on the outcomes of the therapy. When probing acute periodontal lesions, deep probing depths may occur without permanent loss of periodontal attachment. If the acute lesion was not induced by a periodontal cause and if no periodontal etiology arises secondarily, resolving the primary cause of the endoperiodontal lesion can lead to the spontaneous resolution of the pocketing. This results in spontaneous healing of periodontium without the need for intentional periodontal therapy. A clinical dilemma arises when considering periodontal treatment during the acute inflammatory phase of endo‐periodontal pathology. It is advisable to refrain from mechanical root instrumentation particularly if a clear periodontal cause is not apparent, to prevent from iatrogenic damage to periodontal fibers and the potential risk of gingival recessions. However, this does not imply avoiding periodontal therapy entirely for every case. Rather, it is recommended to delay the decision on root instrumentation until a new diagnostic phase is conducted following the healing of the endodontic etiology.

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.

Endodontic-periodontal continuum of tooth: Systematic literature review

INTRODUCTION. The pathogenetic relationship between periodontal and pulp diseases was first described by Simring and Goldberg in 1964. Since then, the term “endodontic-periodontal” lesion (or “endo-perio”) has been used to describe lesions caused by inflammatory products found to varying degrees in both the periodontal and dental pulp tissues. The pulp and periodontium have embryonic, anatomical and functional relationships. The simultaneous presence of changes in pulp tissue and inflammatory periodontal diseases can complicate diagnosis and treatment planning. The etiology, pathogenesis and treatment methods of endodontic-periodontal lesions can vary from quite simple to relatively complex aspects. Knowledge of the basis of concomitant inflammatory processes in the pulp and periodontium is important for making the correct diagnosis.AIM. Carry out a systematic analysis of the literature and summarize the available data on etiopatogenetic relations, diagnostic features and clinical history of endodontic periodontal dental lesions. MATERIAL AND METHODS. A systematic literature analysis was carried out, as well as a manual search in the databases PubMed, Google Search, eLibrary, disserCat, Cyberleninka. Among national and foreign publications corresponding to the topic of this review, 28 publications were selected for systematic analysis, the results of literature review are presented in this article.CONCLUSION. This systematic review found that dental anatomy and the etiology of endodontic periodontal lesions are the basis for difficulties in the diagnosis and treatment of patients with endo-periodontal lesions. Determining the prevalence of infection and the individual characteristics of EPP pathogenesis in patients in this group remains a challenge. In the future, it is necessary to develop new methods of diagnosis, prophylaxis and complex treatment of combined periodontal tissue and tooth pulp, which will improve the prognosis of treatment of injured teeth in the long term.

Endoperiodontal lesions: diagnosis first, then treatment and not always tooth extraction: a cross-sectional survey in Spain and a proposal of a clinical treatment protocol.

Endoperiodontal lesion (EPL) is defined as a pathological communication between pulpal and periodontal tissues. Currently, accurate diagnosis and treatment of this pathology are challenging. This study aims to identify the different endoperiodontal therapies to propose a clinical protocol to simplify and unify the criteria for EPL treatment. Observational cross-sectional study through an electronic survey. This study matches STROBE guidelines. The anonymous questionnaire contained open-ended and close-ended questions and was distributed to dentistry professors of the UPV/EHU and different professionals from Spanish associations and scientific societies. The data collected were analyzed using descriptive and analytical statistics. A total of 128 responses were obtained, of which 120 were active professionals or had not been so for less than 5 years. The majority of professionals were women (65.6%) and from the Basque Country (63.9%). A total of 86.6% reported having complementary studies to a degree or a bachelor's degree. The treatments performed by these professionals were similar to those reported in the literature, which started with root canal treatment when there was an endodontic origin (91.5%), and with basic periodontal treatment when periodontal (51.3%). Considering the current scientific evidence and the clinical practice of professionals in the treatment of EPL, we designed a clinical protocol. This protocol needs validation in larger populations and with longer follow-ups. Key words:Clinical protocol, Dental pulp diseases, Periodontal diseases, Review, Surveys and questionnaires.

Management of Teeth with Grade 3 Endo-Periodontal Lesions by Combined Endodontic and Regenerative Periodontal Therapy.

(1) Background: Severely compromised teeth affected by endo-periodontal lesions are often assigned a "hopeless" prognosis, however, there is only limited evidence available. (2) Methods: In a retrospective study, we evaluated the long-term effectiveness of combined endodontic and regenerative periodontal therapy in teeth with advanced endo-periodontal lesions: 35 patients (age 47-83 years) with a total of 39 teeth diagnosed with grade 3 endo-periodontal lesions were treated by endodontists using an operating microscope followed by regenerative periodontal surgery. (3) Results: Changes in radiographic bone levels (rBl) and probing pocket depths (PPDs) were evaluated after 1 year (T1) and up to 7 years postoperatively (Tfinal). Mean rBL gain was significant with 4.87 ± 3.47 mm after 1 year (T1) and stable results with a mean rBL gain of 4.70 ± 3.37 mm at Tfinal. Mean PPD was significantly reduced from 9.74 ± 2.05 mm at baseline to 5.04 ± 1.61 mm at T1 and to 4.87 ± 2.32 mm at Tfinal. Tooth loss amounted to 10.3% (n = 4) and was due to root fracture. (4) Conclusion: The results suggest that the combined endodontic and regenerative periodontal therapy of endo-periodontal lesions of "hopeless" teeth can lead to favorable long-term results with tooth retention for up to 7 years.

Bicuspidization: salvaging a mandibular molar with endo-periodontal lesion

Teeth are for a lifetime. Losing a tooth will lead to many deleterious consequences starting with the loss of function of the lost tooth and the one coming into occlusion with that. With the increasing life expectancy, the importance of maintaining teeth is highlighted. Replacement is restricted due to financial restrictions and comorbidities contraindicating the replacement options. In a multi-rooted tooth once the area between roots is affected it was routine to extract the tooth as most of the treatment protocols are not giving promising results. The case described here was successfully treated by sectioning the tooth and facilitating access to routine care. Ultimately the tooth is in function as 2 premolars. This has served the tooth to be maintained in the arch at a relatively low cost and least surgical or prosthetic intervention.

Endo-Periodontal Lesions-An Overlooked Etiology of Odontogenic Sinusitis.

The aim of this study was to analyze the oral etiology of patients with odontogenic sinusitis (ODS) and to compare the differences in demographic data, clinical symptoms, extent of sinus involvement, bone penetration of the maxillary sinus floor (MSF) between different etiologies. A retrospective investigation was conducted on 103 patients with ODS recruited from Beijing TongRen Hospital. All enrolled patients underwent sinus CT, nasal endoscopy, and oral examination. A comparison of the patients' clinical symptoms, the extent of involvement of the sinuses, and bone resorption of the MSF according to odontogenic etiologies was conducted. Follow-up was based on symptoms and clinical examination. The most common odontogenic etiologies were endo-periodontal lesions (EPLs, 49.5%), apical periodontitis (AP, 32.0%), and periodontitis (PE, 8.7%). There were statistically significant differences in age (p = 0.002), sex (p = 0.036), inflammation involving the ethmoid sinus (p = 0.037), and bone penetration of the MSF (p < 0.001) between the AP, EPL, and PE groups. There were no significant differences in sinusitis symptoms (p > 0.005) among patients with different odontogenic etiologies. In conclusion, EPL is a neglected oral etiology with a destructive effect on the bone of the MSF, which deserves more attention in diagnosis and treatment.

A case series of root resection of periodontally compromised tooth using an endo- periodontal approach

Endodontic-periodontal combined lesion is a clinical quandary because it is difficult to establish a differential diagnosis and predict a prognosis. Correct diagnosis can be difficult at times; accurate knowledge of the etiologic factors is required for appropriate treatment selection. Endodontic and periodontal therapy are required for the treatment of endodontic-periodontal combined lesions. One treatment option for preserving multirooted teeth with furcation involvement is root resection therapy. This case series discusses root resective therapy and concomitant endodontic management as a treatment option for an endo-periodontal lesion in periodontitis patients, because clinical challenges posed by compromised teeth often complicate treatment plans and compromise long-term outcomes. Based on few reviews of the endodontic and periodontal literature, the role of root resection and treatment strategy are also discussed.

Therapeutic Potential of Chlorhexidine-Loaded Calcium Hydroxide-Based Intracanal Medications in Endo-Periodontal Lesions: An Ex Vivo and In Vitro Study.

Endo-periodontal lesions are challenging clinical situations where both the supporting tissues and the root canal of the same tooth are infected. In the present study, chlorhexidine (CHX)-loaded calcium hydroxide (CH) pastes were used as intracanal medications (ICMs). They were prepared and tested on pathogens found in both the root canal and the periodontal pocket. Exposure to 0.5% and 1% CHX-loaded ICMs decreased the growth of Porphyromonas gingivalis and was effective in eradicating or inhibiting an Enterococcus faecalis biofilm. CH was injected into the root canal of extracted human teeth immersed in deionized water. CHX-loaded ICMs resulted in the transradicular diffusion of active components outside the tooth through the apex and the lateral dentinal tubules, as shown by the release of CHX (from 3.99 µg/mL to 51.28 µg/mL) and changes in pH (from 6.63 to 8.18) and calcium concentrations (from 2.42 ppm to 14.67 ppm) after 7 days. The 0.5% CHX-loaded ICM was non-toxic and reduced the release of IL-6 by periodontal cells stimulated by P. gingivalis lipopolysaccharides. Results indicate that the root canal may serve as a reservoir for periodontal drug delivery and that CHX-based ICMs can be an adjuvant for the control of infections and inflammation in endo-periodontal lesions.

The problem of primary infection in endo-periodontal lesions: a systematic review

The main ways of interrelation of pulp and periodontal tissues are normally the apical openings of the roots of the teeth and additional root canals. In addition, it is important to remember that the bulk of the tooth is dentin, permeated with the smallest dentine tubules, which can also serve as a road in the «endodont-periodontal» system. A doctor who is faced with endo-periodontal lesion (EPL) faces a difficult task, which consists in competent planning of complex treatment and predicting the patient's condition. And one of the main questions that a clinician needs to answer when planning effective prevention and treatment of EPL is «What is primary? ». This systematic review is devoted to the problem of the primacy of infection in EPL, as the most complex and poorly studied.Aim. To summarize the available data on the features of the etiology, pathogenesis, diagnosis and clinical course of EPL.Materials and methods. 3587 publications were found, presented in international lectronic databases: PubMed, Google Search, Ebsco, Embase, Web of Science, ScienceDirect, SciELO and eLibrary from 2000 to 2023. Based on the selection criteria, 65 publications were selected, which included the results of studying the structure of periodontal tissues and tooth pulp, etiology, pathogenesis, as well as the diagnosis and clinical course of EPL. The methodology of this study meets the requirements for systematic reviews and meta-analyses of «PRISMA».Results. The features of pulpo-periodontal relationships are described, data on the prevalence and classification of EPL are presented. Special attention is paid to the etiology of EPL and possible infectious agents involved in the pathogenesis of EPL. The clinical and diagnostic features of the course of EPL and the main approaches to treatment, depending on the primary infection of tissues, are described.Conclusions. The presented detailed systematic analysis showed that the problem of EPL, which has high relevance and significance, has not been studied enough, which does not allow to effectively diagnose, treat, prevent and predict this pathology.

Microbiota present in combined endodontic-periodontal diseases and its risks for endocarditis.

Infective endocarditis (IE) is an inflammatory disease usually caused by bacteria that enter the bloodstream and establish infections in the inner linings or valves of the heart, including blood vessels. Despite the availability of modern antimicrobial and surgical treatments, IE continues to cause substantial morbidity and mortality. Oral microbiota is considered one of the most significant risk factors for IE. The objective of this study was to evaluate the microbiota present in root canal (RC) and periodontal pocket (PP) clinical samples in cases with combined endo-periodontal lesions (EPL) to detect species related to IE using NGS. Microbial samples were collected from 15 RCs and their associated PPs, also from 05 RCs with vital pulp tissues (negative control, NC). Genomic studies associated with bioinformatics, combined with structuring of a database (genetic sequences of bacteria reported for infective endocarditis), allowed for the assessment of the microbial community at both sites. Functional prediction was conducted using PICRUSt2. Parvimonas, Streptococcus, and Enterococcus were the major genera detected in the RCs and PPs. A total of 79, 96, and 11 species were identified in the RCs, PPs, and NCs, respectively. From them, a total of 34 species from RCs, 53 from PPs, and 2 from NCs were related to IE. Functional inference demonstrated that CR and PP microbiological profiles may not be the only risk factors for IE but may also be associated with systemic diseases, including myocarditis, human cytomegalovirus infection, bacterial invasion of epithelial cells, Huntington's disease, amyotrophic lateral sclerosis, and hypertrophic cardiomyopathy. Additionally, it was possible to predict antimicrobial resistance variants for broad-spectrum drugs, including ampicillin, tetracycline, and macrolides. Microorganisms present in the combined EPL may not be the only risk factor for IE but also for systemic diseases. Antimicrobial resistance variants for broad-spectrum drugs were inferred based on PICRUSt-2. State-of-the-art sequencing combined with bioinformatics has proven to be a powerful tool for conducting studies on microbial communities and could considerably assist in the diagnosis of serious infections. Few studies have investigated the microbiota in teeth compromised by combined endo-periodontal lesions (EPL), but none have correlated the microbiological findings to any systemic condition, particularly IE, using NGS techniques. In such cases, the presence of apical periodontitis and periodontal disease can increase IE risk in susceptible patients.

Clinical identification and endodontic management of furcation canals: a case series.

In the case of endodontic infection, the presence of furcation canals can be at the origin of a periodontal lesion located in the furcation. The furcation being very close to the marginal periodontium, this type of lesion can be favorable to the genesis of an endo-periodontal lesion. These furcation canals are lateral canals located on the pulp chamber floor and constitute one of the many physiological communication pathways between endodontic and periodontal tissues. These canals are most often difficult to localize, shape, and to fill because of their small diameter and length. The disinfection of the pulp chamber floor with sodium hypochlorite solution may contribute to the disinfection of furcation canals when they are not identified, shaped, and/or filled. This case series illustrates the endodontic management of visible furcation canals associated with an endo-periodontal lesion. These furcation canals had a large diameter which allowed their identification during the endodontic treatment.

ENDODONTIC-PERIODONTAL LESION

Introduction: Periodontal and pulp tissues are closely related through communication pathways present in the periodontium. This interrelation supports the emergence of endo-periodontal lesions, caused by infectious and irritating products, triggering an inflammatory response Objective: The present study aim to report the treatment of a case of endo-periodontal lesion where endodontic treatment was performed prior to periodontal treatment. Case description: On clinical and radiographic examination, the patient was diagnosed with an endo-periodontal lesion on element 48. The proposed treatment plan was endodontics followed by subgingival scaling. Conclusion: Endodontic treatment associated with periodontal treatment led to the resolution of the case, being observed the absence of pain, absence of abscess/fistula, decreased probing depth and tooth mobility, in addition to bone gain seen radiographically.

INCREASING THE EFFICIENCY OF THE TREATMENT OF ENDOPARODONTAL LESIONS

Chronic inflammation in the periodontium, pulp and periodontium, through the pocket of which the infection can spread towards the root apex and cause a retrograde development of the inflammatory process in the pulp and periapical tissues, is considered as an odontogenic focus.&#x0D; Aim: to study the state of periodontal tissues, periodontitis in the presence of a periapical focus of infection and the dynamics of its change in complex treatment.&#x0D; Material and methods. 150 medical records of a dental patient were studied, among them a randomized controlled study of 100 patients with combined endodontic and periodontal lesions and 50 individuals not burdened by this pathology was also conducted. At the next stage a study of 41 patients with EPL was conducted. The patients were divided into two groups depending on the treatment algorithm: I – with a diagnosis of EPL20 patients of the main group, who, along with standard treatment, received additional therapy with decontamination of CC and laser curettage with a dental diode laser (Picasso Life); II with a diagnosis of EPL 21 patients in the control group with traditional treatment. Evaluation of the effectiveness of traditional and proposed methods of treatment of endoperiodontal lesions was carried out by assessing the degree of gingival bleeding (SBI index (Muhlemann H.R. modified by Cowell I., 1975)) and probing depth (PD).&#x0D; Results. The age indicators for patients of two groups most often varied within 40-49 years. The second most frequent was the age of the subjects, which amounted to 50-59 years. When studying the influence degree of industrial environment factors with irritating and general toxic properties on the frequency of occurrence of EPl, it was found that in the main group 14.0% of patients with this pathology have been working in such conditions for a long time. In addition, in the control group, the number of persons professionally burdened with inflammatory periodontal diseases without signs of apical periodontitis was 16.0%. In the course of further analysis of the obtained anamnestic data, it was revealed that alcohol abuse occurred in the main group in 36.0% of cases, in the control group in 24.0%. Abuse of tobacco products, against the background of which there is inflammation of the gums in the form of hyperemia, edema, bleeding, was noted by half of the patients in the control group and almost the same number of patients in the main group 48.0%, in whom pathological changes in the periapical region were detected in parallel.&#x0D; Conclusion. At certain periods of observation, statistically significant distinguishing intergroup signs were clearly expressed 6 months after the completion of therapeutic and preventive measures, and this trend in a sharp and significant decrease in gum bleeding and periodontal pocket depth continued by the end of observations in the main group when using a laser.

Cemental tears: challenges in the diagnosis and management of an unusual finding associated with rapid localized periodontal and peri-radicular bone loss

A cemental tear is a rare form of root surface fracture whereby a fragment of cementum partially or completely detaches from the root surface at the cemento-dentinal junction or within the body of cementum. Tears are most prevalent in incisors and lead to the breakdown of periodontal issues. Owing to challenges involved in diagnosis, cemental tears may be misdiagnosed because associated clinical and radiographic features closely resemble those seen in vertical root fractures, periodontal abscesses and endo-periodontal lesions. If incorrectly diagnosed, inappropriate and delayed management may result in treatment failure and tooth loss. CPD/Clinical Relevance: Correct diagnosis and timely management of cemental tears can prevent further destruction of periodontal tissues, improve treatment outcomes and increase tooth survival.

Integrated Approach to the Diagnosis and Treatment of Endo-Periodontal Lesions

The purpose of the study was to increase the effectiveness of diagnosis and treatment of patients with endo-periodontal lesions. Materials and methods. The study was conducted from 2019 to 2022 on the basis of the Department of Therapeutic Dentistry of the Azerbaijan Medical University. 41 patients with endo-periodontal lesions who were not burdened with somatic pathology with combined endodontic and periodontal lesions were examined. Radiation diagnostic methods, in particular orthopantomography and intraoral targeted radiographs, were carried out in both groups and in all patients in these groups before the start of therapeutic measures and 6 and 12 months after their completion. The selected groups of patients were practically comparable in gender and age composition (p&gt;0.05). All persons with the same diagnosis, depending on the therapeutic method or treatment algorithm, were divided into two groups: I – with the diagnosis of endo-periodontal lesions – 20 patients of the main group, who, along with standard treatment, were additionally treated with decontamination of root canal and laser curettage with a dental diode laser (Picasso Life); II – with a diagnosis of endo-periodontal lesions – 21 patients of the control group. Root canal treatment: mechanical expansion with endodontic instruments, antiseptic treatment with 3% sodium hypochlorite solution, 17% EDTA solution. To remove dental deposits in the control group, scaling, curettage with Gracie curettes were performed, and an ultrasound device "Piezon Master 600" ™ EMS was used. Cleaning and polishing of the teeth surface was carried out with an abrasive paste. Patients of the main group were additionally treated with a diode laser. Patients of the control group did not undergo such a procedure. Results and discussion. According to the results of the behavioral study, the values of the hygienic index, the gingivitis index and the periapical index before the start of the course of basic therapy for endo-periodontal complications were comparable in both study groups. In terms of follow-up, statistically significant differences were clearly expressed 12 months after treatment. The high frequency of occurrence of combined periodontal and endodontic tissue diseases in male and female individuals, as well as the increase in their prevalence with age, certain difficulties in the diagnosis and treatment of endo-periodontal lesions, causes constant and increased interest in this problem. The results of the index evaluation showed pronounced anti-inflammatory and stimulating bone tissue repair properties of laser therapy. Conclusion. The method of treatment of endo-periodontal complications with the use of a diode laser made it possible to significantly reduce the focus of destruction of bone tissue in the periapical region; contributed to improving oral hygiene and the condition of periodontal tissues. The high efficiency of the proposed combined method of endo-periodontal lesions treatment allows us to recommend it for wide application in practical dentistry

Streptococcus mutans Associated with Endo-Periodontal Lesions in Intact Teeth

A massive periodontal destruction can affect the root canal (RC) system and potentially expose the pulpo-dentinal complex to opportunistic bacteria. Streptococcus mutans is a major pathogen of human caries and periodontal diseases, and its virulence mostly resides in the ability to adhere to collagen and form biofilms, due to collagen-binding proteins (CBPs) Cnm and Cbm. Seventeen patients affected by severe endo-periodontal lesions without caries and/or exposure of pulpal tissue were subjected to tooth extraction and samples for microbiological investigation were collected from the root surface (RS) and RC. The collected swabs were cultivated and subjected to the quantitative real-time PCR (qPCR) for the detection of S. mutans and to the PCR for the cnm/cbm genes investigation, followed by next-generation sequencing (NGS). S. mutans DNA was detected in 12/17 (70.5%) RS samples and in 8/17 (47.0%) RC samples. In the CBPs screening of positive samples, the cnm gene was detected in 4/12 (33.3%) RS and in 1/8 (12.5%) RC samples, whilst all the samples tested negative for the cbm gene. The presence of the cnm gene could enhance the local virulence of the pathogens. Therefore, S. mutans have to be included as potential periodontopathogen bacterium in severe or refractory forms of periodontal diseases.