Endodontic-periodontal Lesions Research Articles

Misdiagnosis or Missed Diagnosis? Cone-Beam Computed Tomography-Aided Multidisciplinary Management of Maxillary Central Incisor with Palatogingival Groove

Palatogingival groove is a developmental anomaly that is most often seen on maxillary incisors, with a predilection for lateral incisors. It begins in the central groove and can extend to varying lengths and depths into the root. This groove can communicate with the pulp internally and periodontium externally, thereby establishing a milieu for the development of complex endodontic-periodontic lesion. In this article, we report multidisciplinary management of a maxillary central incisor, which was mistaken to be a vertical root fracture instead of a palatogingival groove. We also discuss the significance of early recognition of this lesion, differential diagnosis, and it's interdisciplinary management with the aid of cone-beam computed tomography.

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<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<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.

A qualitative and semiquantitative SEM study of the morphology of the biofilm on root surfaces of human teeth with endodontic-periodontal lesions.

Over the last decades, scanning electron microscopy (SEM) proved to be invaluable for ultrastructural investigation, allowing imaging of the overall appearance and/or specific features of oral biofilms, e.g., microbial colonies and individual cells, glycocalyx, the presence of inorganic products. The aim of this study was the observation and evaluation of the morphology of the biofilm of endodontic-periodontal lesions (EPL) with a modified protocol involving a simplified histologic sample preparation and a low-vacuum SEM examination method. Twenty-one teeth with endodontic-periodontal involvement, extracted for periodontal reasons, were carefully washed with saline, underwent fixation in modified Karnovsky solution and were dehydrated in alcohol series. Samples were examined under low-vacuum SEM. Radicular surfaces were evaluated qualitatively and semiquantitatively for several characteristics, including the presence of bacterial types, the biofilm morphology and the content of root resorptions. Radicular surfaces were divided in four conventional zones Surfaces were evaluated for several characteristics: Presence of bacterial types, biofilm morphology, presence of root resorptions. High-quality images, relevant for endodontic-periodontal biofilms were collected. Continuous, established biofilm was found on all examined surfaces, its detection varying from 19% of the samples on the wall of cemental cone to 52.3% on the radicular surface of the periodontal pocket. Observed microorganisms included cocci, rods an filaments. Spirils and motile bacteria were only accidentally found. SEM investigation of surfaces involved in EPL revealed less surfaces covered by mature biofilm (in only 28.5% of the samples in the ‘transition zone’), especially rods and filaments associated with cemental resorptions and calculus. Biofilm elements were better represented in periodontal pockets than in other zones of EPL (detected in up to 81% of the samples). A strong correlation between mature biofilm and the presence of cocci appears on all investigated zones (P<0.01). Microbiota appeared to be morphologically similar in apical and periodontal areas, especially in old EPL.

Healing of an endodontic-periodontal lesion caused by trauma. A Case report

Endodontic-periodontal lesions can originate from infections of the periodontium or tissues of the dental pulp. Dental trauma to the face can affect teeth and cause pulp necrosis, which, in turn, leads to periodontal breakdown, pocket formation, and alveolar bone loss. These types of lesions are categorized as retrograde periodontal lesions of endodontic origin, which is the same condition of the case presented in this report. A 37-year-old healthy male had trauma 6 months ago and reported with a chief complaint of oral pain while biting on his maxillary right canine. Clinical examination revealed Grade II mobility and a deep periodontal pocket. Radiographic examinations showed an advanced bone resorption around the tooth. Pulp necrosis with symptomatic apical periodontitis was diagnosed. Root canal treatment was performed and the case was followed for one year. Thorough history taking and investigation led to successful outcome, with the tooth exhibiting complete soft - and hard-tissue healing.

Management of complex palatoradicular groove in maxillary lateral incisor

Palatoradicular grooves are the developmental anomalies that owing to complexity in morphology and extent along the root length, can be an aetiology for periodontal destruction, endodontic involvement or both. We report a case of a 34 years male patient who presented with a chief complaint of pain and swelling in his upper left front region of jaw since one month. Clinical and radiographic examination confirmed presence of periodontal-endodontic lesion with respect to 22. Endodontic treatment followed by periodontal debridement, regenerative procedures, odontoplasty and sealing of the groove was done. Combined endodontic-periodontal approach was successful in resolving the pathology with satisfactory and stable healing seen clinically and radiographically for upto six months postoperative.

Odontogenic infection as a predisposing factor for pathologic disorder development in maxillary sinus.

To investigate an association between odontogenic infections (OI) and maxillary sinuses pathologic disorder (MSPD). The distance between the sinus floor and the root apex of upper posterior teeth was also assessed. Out of 4,402 cone beam computed tomography scans, 230 were selected, and 431 teeth were evaluated regarding the presence of OI: bone loss with furcation involvement, periapical and endodontic-periodontal lesions. The maxillary sinuses were assessed regarding the presence of MSPD, which was considered as mucosal thickening, opacification of the sinus and mucous retention cyst. There was a significant association between OI and MSPD (p<.001). Periodontal bone loss with furcation involvement, periapical lesions and endodontic-periodontal lesions increased the risk of opacification of the sinuses by 11.6, 34.1 and 228.8 times, respectively. The frequency of the different types of MSP showed not to be associated with a group of teeth or dental root. Conversely, the presence of MSP was associated with a significant shorter distance between the palatine root apex and the sinus floor (p<.001). There is a relationship between infectious process of teeth and MSPD. The proximity between the apex of palatine roots and the maxillary sinus floor showed to be a predisposing factor for MSPD.

Hojení pulpo-parodontální léze po nechirurgickém ošetření

Úvod a cíl práce: Pulpo-parodontální postižení jsou častým problémem postihujícím zuby. Současná přítomnost onemocnění souvisejícího se zubní dření a zánětlivého onemocnění parodontu může komplikovat diagnózu a plánování léčby. Největší výzvou při léčbě parodontitidy u zubů s onemocněním endodontického původu je zasažení mezikořenového prostoru. Bez ohledu na to, zda je patologie endodontického a/nebo parodontálního původu, jsou zasaženy tkáně parodontu a jejich hojení závisí na stanovení správné diagnózy a výběru vhodné terapie. Systematický postup při diagnostice pomáhá při identifikaci a léčbě pulpo-parodontálních postižení. Tento článek ukazuje úspěšné hojení pulpo-parodontálních lézí po nechirurgickém endodontickém ošetření. Metody: Prezentovány jsou dva případy se zjištěným pravým kombinovaným pulpo-parodontálním postižením. Léčba zahrnovala endodontické ošetření a současné subgingivální ošetření. Výsledky: Periapikální projasnění byla po šesti měsících od ošetření výrazně zmenšena. Závěr: Pulpo-parodontální postižení mají komplexní povahu a rozmanitou patogenezi. Dlouhodobá prognóza po léčbě pulpo-parodontálních lézí závisí na správné diagnóze a pečlivém endodontickém ošetření následovaném v případě potřeby léčbou parodontitidy.

Endodontic–periodontic lesion management: A systematic review

ObjectiveThis systematic review was aimed to understand the management of endodontic–periodontic lesion. MethodsPubmed and Wiley online searches were conducted to identify articles published in dental journals until April 2018. Manual searches of published full-text articles and related reviews were performed afterwards. ResultA total 16 studies were selected for inclusion, with 22 patients as subjects. All studies showed the decreased probing depth (PD) after treatment or healing of the lesion. All studies included were case report with treatment using root canal treatment (RCT) alone or RCT combination with bone graft or RCT with platelet rich fibrin (PRF). ConclusionTreatment using root canal treatment (RCT) combination with bone graft was mostly used than the other treatment option in endo-perio lesion.

Endodontic Peri-implant Defects: A New Disease Entity

Peri-implantitis is becoming a frequent complication observed around dental implants. An endodontic infection of a nearby tooth or an immediate implant placement in an inflamed bone socket from failing endodontic therapy has been associated with retrograde peri-implantitis (RPI), a condition that presents with radiographic lucency at the “apex” of an implant. However, current classification schemes do not capture endodontic lesions that may manifest as coronal or intrabony lesions associated with dental implants. As a result, such cases may be mistreated. Here we present for the first time 2 cases in which peri-implant bone loss occurred in the coronal half of the implant adjacent to a tooth with an endodontic-periodontic lesion and was resolved via endodontic therapy or tooth extraction as indicated. This proof of concept report aimed to introduce endodontic peri-implant (“endo-implant”) defects and increase vigilance, which may help prevent overtreatment or mistreatment of such cases.

Comparative evaluation of 2% turmeric extract with nanocarrier and 1% chlorhexidine gel as an adjunct to scaling and root planing in patients with chronic periodontitis: A pilot randomized controlled clinical trial.

Context:Nanoparticles, owing to their smaller size, penetrate regions inaccessible to other delivery systems, such as periodontal pockets. Thus, the present study aimed to comparatively evaluate efficacy of 2% curcumin with nanocarrier and 1% chlorhexidine gel as a local drug delivery (LDD) in the treatment of periodontal pockets.Materials and Methods:Forty-five chronic periodontitis patients with pocket depth 5–7 mm in two or more teeth were selected. Full-mouth scaling and root planing (SRP) was done for all patients followed by random allocation to the three treatment groups, namely SRP group (Group 1), 2% curcumin with nanogel (Group 2), and 1% chlorhexidine gel (Group 3). Clinical parameter assessment and microbiological analysis of subgingival plaque samples for Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), and Tannerella forsythia (Tf) was done at baseline, 21st day, and 45th day.Results:The results showed that when the two LDD agents were used as an adjunct to SRP in chronic periodontitis, there was an improvement in all clinical parameters. Evaluation of microbiological parameters also showed a significant reduction in Aa, Pg, and Tf levels. Comparison of 2% turmeric extract with a nanocarrier system with 1% chlorhexidine gel showed that both the agents had a comparable antibacterial effect on the three selected periodontopathic bacteria.Conclusion:The present study showed that both the LDD agents showed an effective improvement of clinical and microbiologic parameters. 2% curcumin delivered with a nanocarrier system showed results comparable to chlorhexidine gel and hence shows promising future as an LDD agent in the treatment of periodontal pockets.

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

Interdisciplinary management of root perforation along with regeneration of bony fenestrations and dehiscence

A surface alveolar bony defect communicating with the root canal perforation can be either endodontic or periodontal origin. Breach in the continuity of the cortical plate may lead to the development of dehiscence and fenestration alveolar defects. This case report discusses the regeneration of periodontal tissues in fenestration and dehiscence defects that had developed around traumatized incisors, using a type I collagen membrane and bone graft along with root perforation repair emphasizing the requirement of an interdisciplinary approach for the management of endodontic-periodontal lesions. The alveolar defects such as fenestration and dehiscences profoundly affect the prognosis of both periodontal and endodontic treatment outcomes; therefore, it should be carefully diagnosed and managed.

Is Intentional Replantation Appropriate for Treatment of Extensive Endodontic-periodontal Lesions Related to Palatogingival Groove?

This report describes the cases of two patients with a maxillary lateral incisor with palatogingival groove and extensive endodontic-periodontal lesions. Although it is reported that acceptable periodontal status is of great importance in case selection in intentional replantation, it is suggested in this report that intentional replantation could be chosen instead of immediate extraction if extensive endodontic-periodontal lesions exist in a tooth with palatogingival groove. The gingival margin position and gingival papilla were well preserved and the bone defect was almost completely repaired. This was beneficial to the aesthetic prosthodontic treatment and implantation, although external root resorption was observed.

Interdisciplinary Approach in Periodontology - A Mini-Review and A Report of Two Complex Cases

Increasing life expectancy, higher quality of biomaterials used in dentistry and the rapid evolution of clinical procedures, has led to more demanding patient requests and more complicated treatment choices. Such complex cases require holistic management, which frequently mandates clinicians to cooperate in a multidisciplinary approach, in order to fulfil therapeutical objectives and to provide successful treatment concerning functional rehabilitation and aesthetical enhancement. Periodontology cannot be practised in isolation but has to be combined with other fields of dentistry, since periodontal diseases are quite prevalent and affect oral health in various ways. It is evident that these interactions and interrelationships between periodontology practice and other dental fields, such as endodontics, prosthodontics and orthodontics are quite crucial so as the utmost care to be delivered. Combined endodontic-periodontal lesions, adult orthodontics, especially in patients having been treated for periodontitis, prosthetic restoration and dental implant placement in patients with history of periodontitis are some challenging treatment modalities that may require interdisciplinary approach. In the first case reported, non-surgical as well as surgical periodontal treatment and periodontal health stabilization created the proper background for successful orthodontic treatment to be applied in a patient with severe chronic periodontitis. In the second case, periodontal therapy and surgical lengthening of the clinical crowns, with respect to biological width fundamentals, provided more favourable conditions in order a patient with alternative passive eruption and gummy smile to be restored prosthetically.

Endodontic microsurgery: outcomes and prognostic factors

This review addresses endodontic microsurgery procedures compared with traditional surgery and aims to review factors related to the success and failure of endodontic microsurgery from the existing literature. Periodontal involvement and tooth position are patient- and tooth-related factors known to have an effect on the outcome of apical surgery. Factors related to successful outcome have been reported and include whether the mineral trioxide aggregate used to obturate the apical portion of the root after surgery was fast or slow setting. Although not statistically significant, larger difference in the success rate between slow- and fast-setting MTA groups was observed in teeth with endodontic-periodontal lesions than in teeth with isolated endodontic lesions suggesting that the faster setting root-end filling material is most advantageous, particularly when endodontic lesions have periodontal involvement. Endodontic microsurgery has witnessed major advances and is currently regarded as an integral part of standard endodontic treatment. Improved visibility and illumination because of the operating microscope, advances in ultrasonic instrument technology, and the development of more biocompatible root-end filling materials have contributed to the technical advances that have led to higher success rates in endodontic microsurgery compared with traditional surgery.

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.

Clinico-radiologic features of molar-incisor malformation in a case series of 38 patients: A retrospective observational study.

Molar-incisor malformation (MIM) is a recently defined dental abnormality of molar root and incisors, and introduced as one of the causes of periapical and periodontal abscess. The purpose of this study was to investigate the clinical and radiological features of MIM, with special emphasis on various medical history. A total of 38 patients with MIM were included in this study. Radiographic features and clinical data, including medical history, chief complaint, associated complications, treatment, and prognosis, were retrospectively investigated. On radiographs, the affected molars showed short, slender, underdeveloped roots and constricted pulp chambers. All affected incisors and canines exhibited dilacerated short roots, wedge-shaped defect on the cervical part of the crown. Complications included periodontal bone loss (52.6%), endodontic lesion (50.0%), and endodontic-periodontal lesion (28.9%). The medical histories of the patients with MIM indicate that almost all (94.7%) were hospitalized due to problems during the neonatal period. MIM may cause various dental problems, such as periapical and periodontal abscess and early loss of the affected teeth. The early diagnosis of MIM on radiographs and appropriate treatment will contribute to a favorable prognosis, especially for young and adolescent patients.

An unusual presentation of a periodontal-endodontic lesion

Periodontal-endodontic (perio-endo) lesions involve pulpal and periodontal disease in the same tooth and are seen routinely by dental practitioners. An unusual presentation of a perio-endo lesion in the lower left mandible is demonstrated. It caused significant buccal expansion and perforation of the lingual plate, and was provisionally diagnosed as a malignancy. CPD/Clinical Relevance: This case has highlighted the need for clinicians to be aware of the unusual way that periodontal-endodontic lesions may present both clinically and radiographically.

Vertical root fracture as an endodontic–periodontal lesion

Vertical root fracture as an endodontic–periodontal lesion