Endodontic Lesions Research Articles

A New Scoring System for Assessment of Periodontal - Endodontic Lesions Based on Cone Beam Computed Tomography

A New Scoring System for Assessment of Periodontal - Endodontic Lesions Based on Cone Beam Computed Tomography

Host Modulation in the Management of Endodontic Periodontic Lesions - A Report of 3 Cases

Host Modulation in the Management of Endodontic Periodontic Lesions - A Report of 3 Cases

Multidisciplinary Approach to the Conservative and Regenerative Management of Endo-Perio Lesion

This case report evaluates the clinical and radiographic response of biphasic calcium phosphate (ossify) when used in combination with bioresorbable membrane (sybograft - GBR) for the treatment of intrabony defect around multi-rooted teeth with an endodontic and periodontal lesion. A 47-year-old female patient with an endo-perio lesion in the left mandibular first molar was initially treated with endodontic therapy. After endontic management of the teeth a full-thickness flap reflected, complete degranulation and root planing was performed. An allograft was then used to fill the defect and a GBR membrane was placed over the filled defect. Radiographs, clinical probing depths, and attachment levels were obtained before treatment, 3, 6, 9 and 24 months following treatment. Reduction in pocket depth and gain in clinical attachment level were observed during follow up. This case report demonstrates that proper diagnosis, followed by removal of etiological factors and utilizing the guided tissue regeneration technique combined with osseous grafting, will restore health and function of a tooth with severe bone loss caused by an endo-perio lesion. This report highlights a conservative and regenerative approach to the management of endo-perio lesion rather than a radical approach such as hemisection.

Combined treatment of a lateral incisor with palato-radicular groove: 1 year follow-up

AbstractPeriodontic - endodontic lesion with a palato-radicular groove as a contributing factor for periodontitis is the most important diagnostic and therapeutic challenges faced by periodontists and the maxillary lateral incisors are the most frequently affected teeth. These developmental grooves promotes the accumulation of plaque and calculus, which destroys the sulcular epithelium and later deeper parts of the periodontium, finally resulting in the formation of a severe localized periodontal lesion since proper cleaning of that site is difficult, if not impossible, for the patient. There are different types of treatment such as scaling and root planning, odontoplasty, amalgam restoration, and extraction of the tooth to treat palatogingival groove and associated periodontal bone defects. In this case, a successful management of an endodontic-periodontal combined lesion by combined treatment and guided tissue regeneration was presented.

Promotion of endodontic lesions in rats by a novel extraradicular biofilm model using obturation materials.

Although extraradicular biofilm formation is related to refractory periapical periodontitis, the mechanism of extraradicular biofilm development, as well as its effect on periapical lesions, is unknown. Therefore, we aimed to develop an in vivo extraradicular biofilm model in rats and to identify and quantify extraradicular biofilm-forming bacteria while investigating the effect of extraradicular biofilms on periapical lesions. Periapical lesions were induced by exposing the pulpal tissue of the mandibular first molars of male Wistar rats to their oral environment. Four weeks later, gutta-percha points were excessively inserted into the mesial root canals of the right first molars (experimental sites) but not the left first molars (control sites). After 6 and 8 weeks of pulp exposure, the presence of extraradicular biofilms was confirmed histomorphologically, and biofilm-forming bacteria were identified by using classical culture methods. The biofilms were observed in the extraradicular area of the experimental sites. Similar species were detected both inside and outside the root canals. The bacterial count, quantified by real-time PCR assays, in the extraradicular area gradually increased in the experimental sites until 20 weeks after pulp exposure. After 8 weeks of pulp exposure, the periapical lesion volume that was measured by micro-computed tomography was significantly larger in the experimental sites than in the control sites (P < 0.05 by Welch's t test). These results suggest that we developed an extraradicular biofilm model in rats and that extraradicular biofilms affect developing periapical lesions.

Periodontic endodontic lesions: standardized diagnostic and therapeutic indications

牙体硬组织、牙髓组织以及牙齿周围的牙周支持组织可以视作是一个相对完整的生物功能单元.牙齿的硬组织将牙髓和牙周组织分开,使其各自承担不同的生理角色,但二者之间也保持着相互联系.牙周组织和牙髓组织经由根尖孔、副根管、侧支根管和牙本质小管等互相连接,共同维持牙齿的生理功能.因此,当牙髓、牙周组织单独或同时发生病变,它们就可能相互影响,出现牙周病和牙髓病两种疾病联合的症状和体征,即牙周-牙髓联合病变(periodontic endodontic lesion)。

Nonsurgical Management of Endodontic Perforation at Molar Furcation Region

ABSTRACT The periodontal ligament and root canal system have a common developmental, anatomic and functional relationship and theoretically an infection originating in one tissue can affect the other also. The simultaneous existence of endodontic and inflammatory periodontal lesions is a clinician's nightmare as it can complicate the diagnosis and an accurate diagnosis may be particularly difficult when a sinus tract originating from the endodontic lesion drains along the periodontal ligament space, mimicking periodontal disease. Thorough diagnostic testing to confirm pulp necrosis or periodontal disease becomes critical when attempting to diagnose the specific disease entity accurately and then deliver suitable treatment. A blanket diagnosis for any such lesions regardless of primary etiology can prove to be a disaster. A case report of an iatrogenic endodontic perforation of the pulp chamber at the region of molar furcation and managed by nonsurgical therapy is presented in this paper. How to cite this article Warrier S. Nonsurgical Management of Endodontic Perforation at Molar Furcation Region. Int J Experiment Dent Sci 2014;3(2):117-119.

Clinical effectiveness of combining platelet rich fibrin with alloplastic bone substitute for the management of combined endodontic periodontal lesion

The term "endo-perio" lesion has been proposed to describe the destructive lesion resulting from inflammatory products found in varying degrees in both the periodontium and the pulpal tissues. In most of the cases, clinical symptoms disappear following successful endodontic therapy. However failure after conventional root canal treatment calls for surgical intervention. A 35 year old male patient with endo-perio lesion in right maxillary lateral incisor was treated with platelet rich fibrin (PRF) and alloplastic bone substitute after conventional endodontic therapy. At the end of 6 months there was gain in clinical attachment, increased radiographic bone fill and reduction in probing depth which was maintained till 18 month follow-up. Present case report aims to evaluate the efficacy of PRF and alloplastic bone substitute in the management of intrabony defect associated with endo-perio lesion in maxillary lateral incisor because the healing potential of PRF and bone graft has not been widely studied in endodontics. The use of PRF allows the clinician to optimize tissue remodelling, wound healing and angiogenesis by the local delivery of growth factors and proteins. The novel technique described here enables the clinician to be benefited from the full regenerative capacity of this autologous biologic material.

下顎第二大臼歯の特異性を考慮し保存に努めた症例 ——樋状根，歯内－歯周病変，垂直性骨吸収への対応——

下顎第二大臼歯の歯内－歯周病変は，樋状根など，歯内療法に困難な要素が多く治療の見通しを立てることが難しい．本症例は，全身状態に様々なリスクをかかえ，外科処置を選択できない条件下で，樋状根，歯内－歯周病変，垂直的骨吸収などの問題を有する下顎第二大臼歯に対して，CBCT 画像診断，根管形状に即した根管拡大，自然移動により良好な結果を得たものである．【顎咬合誌 34（3）：245-251，2014】

Management of endodontic-periodontic lesion of a maxillary lateral incisor with palatoradicular groove

Presence of palatal radicular grooves are considered to be an important contributing factor to the development of localized periodontitis, as it favored the accumulation and proliferation of bacterial plaque deep into the periodontium. Pulp involvement could result due to the introduction of bacterial toxins through channels that existed between the root canal system and the groove. Early diagnosis, elimination of infl ammation and correction of anatomic complications are the key to a favorable outcome for managing palatoradicular groove. Present report describes successful management with an interdisciplinary approach of maxillary lateral incisor with combined endodontic periodontic lesion associated with palatoradicular groove.

Diagnosis and treatment of teeth with primary endodontic lesions mimicking periodontal disease: three cases with long-term follow ups

A tooth with primary endodontic disease that demonstrates a periodontal defect might be extracted because of misdiagnosis as severe periodontal disease or a vertical root fracture. The aim of this case report was to demonstrate the long-term survival of endodontically treated teeth, which had been initially considered unsavable. With meticulous evaluation including the patient's dental history, clinical and radiographic examinations, teeth with primary endodontic lesions could be differentiated and saved after proper root canal treatment. Pain history, vitality test, and radiographic examinations, as well as a general periodontal condition check with periodontal probing on an affected tooth, might be the key methods to differentiate endodontic pathosis from that of periodontal disease.

Pulp Orperiodontium??-Diagnosis and Management of Endo - Perio Lesion

A female patient of 16 years of age reported with a chief complain of severe pain , swelling and pus discharge with respect to right lower back tooth region since two days,with a previous history of sensitivity to hot and cold. On the basis of case history ,clinical and radiographic findings case was diagnosed as primary endodontic lesion with secondary periodontal involvement,and was decided to treat it first endontically followed by periodontal surgery based on the principles of periodontal regeneration by using synthetic bonegraft and resorbable GTR membrane.At the end of 6months the case showed the positive results with gain in both soft and hard tissue parameters .

Nonendodontic Lesions Misdiagnosed as Apical Periodontitis Lesions: Series of Case Reports and Review of Literature

IntroductionThis study aimed to analyze cases referred from a reference service in oral pathology that were initially misdiagnosed as periapical lesions of endodontic origin and to perform a review of the literature regarding lesions located in the apical area of teeth with a nonendodontic source. MethodsA survey was made of clinical cases derived from the service of oral pathology from 2002 to 2012. The pertinent literature was also reviewed using ScienceDirect and PubMed databases. The lesions were grouped into benign lesions mimicking endodontic periapical lesions (BLMEPLs), malignant lesions mimicking endodontic periapical lesions (MLMEPLs), and Stafne bone cavities. The clinical presentations were divided into lesions with swelling without pain, lesions with swelling and pain, and lesions without swelling but presenting with pain. ResultsThe results showed that 66% (37/56) of cases represented benign lesions, 29% (16/56) malignant lesions, and 5% (3/56) Stafne bone cavities. The most commonly reported BLMEPLs were ameloblastomas (21%) followed by nasopalatine duct cysts (13.5%). The most frequently cited MLMEPLs were metastatic injuries (31.5%) followed by carcinomas (25%). The main clinical presentation of BLMEPLs was pain, whereas that of MLMEPLs was swelling associated with pain; Stafne bone cavities displayed particular clinical findings. ConclusionsClinical and radiologic aspects as well as the analysis of the patients' medical history, pulp vitality tests, and aspiration are essential tools for developing a correct diagnosis of periapical lesions of endodontic origin. However, if the instruments mentioned earlier indicate a lesion of nonendodontic origin, a biopsy and subsequent histopathological analysis are mandatory.

Prognostic Factors of Clinical Outcomes in Endodontic Microsurgery: A Prospective Study

IntroductionThis prospective study examined the potential prognostic factors of endodontic microsurgery and compared the predictors of an isolated endodontic lesion with those of both an isolated endodontic lesion and an endodontic-periodontal lesion. MethodsData were collected from the Microscope Center of the Department of Conservative Dentistry at the Dental College of Yonsei University, Seoul, Korea, between March 2001 and March 2011. A total number of 584 teeth were included, and all clinical procedures were performed by a single operator (E.K.). The evaluation was performed at least 1 year after surgery. For statistical analysis of the predisposing factors, the chi-square test and logistic regression were performed. ResultsOf the 584 cases treated, 431 cases came for recall after a period of at least 12 months. Sex (female), tooth position (anterior), arch type (maxilla), and lesion type (isolated endodontic lesion) were found to have a positive effect on surgical outcome. With regards to isolated endodontic lesions, the tooth position (anterior), arch type (maxilla), and type of restoration (single/splinted crown, short bridge, and removable partial denture abutment) were found to be pure positive predictors. ConclusionsIn endodontic microsurgery, it is likely that preoperative factors, particularly the tooth position and arch type, have a greater influence on the healing outcome than intra- and post-operative factors.

Interdisciplinary Approach in Treatment of Endodontic- Periodontal Lesion : A Case Report

Endodontic periodontal combined lesion is a clinical dilemma because making a clinical diagnosis and deciding a prognosis are difficult. The treatment of endodontic periodontal lesion combined requires both endodontic therapy and periodontal regenerative procedures. This case report evaluates the prognosis of endo- perio lesion which was first treated with conventional endodontic therapy and then followed by periodontal therapy. At a three month post operative evaluation there was gain of clinical attachment level and reduction in probing depth with radiographic evidence of substantial alveolar bone gain.DOI: http://dx.doi.org/10.3126/jucms.v1i3.8768Journal of Universal College of Medical Sciences Vol.1(3) 2013: 58-61

Patología implanto-endodóncica: concepto, tipos, diagnóstico, tratamiento y prevención

The implant-endodontic pathology is described in the literature as a cause of apical periimplantitis, understood to be an osteolytic lesion that appears in the apical region of the implant during the coronal osteointegration normally. This implant-endodontic pathology researches the relation of endodontic and implants apical lesions leading to infection contiguity between teeth and implants. The first way of contamination is implant-tooth, when the implant placement causes necrosis of the adjacent tooth and subsequent contamination of the implant; the second way is tooth-implant, when there is an exacerbation of latent apical lesion in a tooth, root canal or not, after placing an implant adjacent to it, resulting in apical periimplantitis later. In this work we have summoned the cases of occurring periimplantitis by apical residual infection present in the socket of an extracted tooth with apical periodontal pathology and replaced by an implant. This review aims to make an update of the relationship between periimplantitis and endodontics.

The Relation of Endodontic-Periodontal Lesion and Therapy

The correlation between endodontic-periodontal lesion has been documented well be researches. Endodontic lesion originates from pulp, while periodontal lesion originates from periodontal tissues. Anatomically they are connected by apical foramen, lateral canal and accessories, as well as dentin tubules. The correlation appeared as the endodontic defect can be from periodontal lesion, or a periodontal defect is from a pulp tissue. Together they can emerge and form a combination lesion. Endodontic infections have been highly correlated with deeper periodontal pockets and furcation involvement in mandibular, the causal relationship between the two pathoses has not yet been established. This consensus supports the influence of degenerated or inflamed pulp that can happen on the periodontium; but not all researchers agree about the effect of periodontal disease on the pulp. Conclusion: The mechanism of endo-perio lesion need to taken care in order to have appropriate diagnostic so that the right therapy would be able to keep the teeth in the oral cavity.

Immediate Placement of Implants into Infected Sites: A Systematic Review

Traditionally, before placing dental implants, the compromised teeth are removed and the extraction sockets are left to heal for several months. To preserve the alveolar bone level from the collapse caused by healing and to reduce treatment time in situations in which tooth extraction precedes implant placement, some clinicians began to install the implant immediately into the postextraction socket without waiting for the site to heal. The purpose of this study was to review the literature regarding treatment outcomes of immediate implant placement into sites exhibiting pathology after clinical procedures to perform the decontamination of the implant's site. The following questions were raised: Does the presence of periodontal or endodontic infection affect immediate implant placement success? What is suggested to address the infection in the socket prior to immediate placement? An electronic search in PubMed (U.S. National Library of Medicine, Bethesda, MD, USA) was undertaken in March 2013. The titles and abstracts from these results were read to identify studies within the selection criteria. Eligibility criteria included both animal and human studies, and excluded any review and case reports articles. The publication's intervention had to have been implant placement into a site classified as having an infection (periapical, endodontic, perioendodontic, and periodontal). The search strategy initially yielded 706 references. Thirty-two studies were identified within the selection criteria, from which nine were case reports and review articles and were excluded. Additional hand-searching of the reference lists of selected studies yielded five additional papers. The high survival rate obtained in several studies supports the hypothesis that implants may be successfully osseointegrated when placed immediately after extraction of teeth presenting endodontic and periodontal lesions, provided that appropriate clinical procedures are performed before the implant surgical procedure such as meticulous cleaning, socket curettage/debridement, and chlorhexidine 0.12% rinse. However, more randomized controlled clinical trials with a longer follow-up are required to confirm this procedure as a safe treatment. Moreover, the outcome measures were not related to the type of infection; the classification of infection was often vague and varied among the studies. The benefits of antibiotic solution irrigation and systemic antibiotic administration in such conditions are not yet proved and remain unclear.

Repair of a root perforation by using MTA: a case report

Root perforations are accidental events that may occur during the treatment, causing tissue inflammation and alveolar bone loss of integrity of the periodontium. In such cases, the radiological evidence is fundamental in the formulation of the diagnosis, in the choice of therapy (surgical or non-surgical) and finally for the assessment of prognosis of the dental element. In non-surgical treatment of endodontic lesions, the material used for the repair of the defect root should have biocompatibility, antibacterial activity, ability to induce healing of periodontal tissues and radiopacity. The Mineral Trioxide Aggregate (MTA) is a silicate-based cement introduced in dental clinical practice with good radiopacity, biocompatibility and bone induction. This article describes the use of MTA in endodontic repair of a perforation of the middle third root and the success of non-surgical treatment was dimonstrated radiographicaly.

A Novel Method to Estimate the Volume of Bone Defects Using Cone-Beam Computed Tomography: An In Vitro Study

IntroductionThe routine use of high-resolution images derived from 3-dimensional cone-beam computed tomography (CBCT) datasets enables the linear measurement of lesions in the maxillary and mandibular bones on 3 planes of space. Measurements on different planes would make it possible to obtain real volumetric assessments. In this study, we tested, in vitro, the accuracy and reliability of new dedicated software developed for volumetric lesion assessment in clinical endodontics. MethodsTwenty-seven bone defects were created around the apices of 8 teeth in 1 young bovine mandible to simulate periapical lesions of different sizes and shapes. The volume of each defect was determined by taking an impression of the defect using a silicone material. The samples were scanned using an Accuitomo 170 CBCT (J. Morita Mfg Co, Kyoto, Japan), and the data were uploaded into a newly developed dedicated software tool. Two endodontists acted as independent and calibrated observers. They analyzed each bone defect for volume. The difference between the direct volumetric measurements and the measurements obtained with the CBCT images was statistically assessed using a lack-of-fit test. A correlation study was undertaken using the Pearson product-moment correlation coefficient. Intra- and interobserver agreement was also evaluated. ResultsThe results showed a good fit and strong correlation between both volume measurements (ρ > 0.9) with excellent inter- and intraobserver agreement. ConclusionsUsing this software, CBCT proved to be a reliable method in vitro for the estimation of endodontic lesion volumes in bovine jaws. Therefore, it may constitute a new, validated technique for the accurate evaluation and follow-up of apical periodontitis.