Endodontic-periodontal Lesions Research Articles

Prevalence of red and orange microbial complexes in endodontic-periodontal lesions: a systematic review and meta-analysis.

This systematic review assesses the prevalence of microbial complexes in endodontic-periodontal lesion. Nine databases were searched through August 2020. Experts were consulted to indicate additional studies. Studies were blindly selected by two reviewers based on pre-defined eligibility criteria. Studies that evaluated the prevalence of microbial orange and red complexes among patients with endodontic-periodontal lesion were considered eligible. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. From 572 articles found on all databases, 11 clinical studies were finally included. The following microorganisms were investigated: P. gingivalis, T. forsythia, T. denticola, F. nucleatum, F. periodonticum, P. micra, P. intermedia, P. nigrescens, S. constellatus, C. gracilis, C. rectus, C. showae and E. nodatum. Considering the orange complex, P. micra, E. nodatum and S. constellatus were prevalent in both root canal and periodontal pockets. P. gingivalis and T. forsythia belonging to the red complex were prevalent only in periodontal pockets. The red complex microorganisms were not found very frequently in root canal. There is a similarity between the microbiome of root canal and periodontal pockets, with prevalence of the three microorganisms of the orange complex. Two microorganisms from the red complex were prevalent only in periodontal pockets. The prevalence of specific microorganisms in endodontic-periodontal lesion is important to understand the microbiological profile of the patients involved and to correlate it with possible clinical and repair conditions of this pathology.

Impact of Periodontal Attachment Loss on the Outcome of Endodontic Microsurgery: A Systematic Review and Meta-Analysis

Background and Objectives: Endodontic microsurgery (EMS) aims to eradicate the sources of infection once the apical root resection removes most of the infected anatomical structures and repairs potential procedural errors in the apical region. An endodontic-periodontal lesion yields a pathological communication between the pulp and the periodontium. The purpose of this systematic review and meta-analysis is to evaluate the impact of periodontal attachment loss on the outcome of teeth submitted to EMS. Materials and Methods: PRISMA guidelines were followed. An electronic search was performed in EBSCOhost, Embase and PubMed databases with the following search key: (“endodontic microsurgery” AND “outcome”). No filters were used concerning the year of publication or language. Only randomized clinical trials, prospective and retrospective clinical studies in humans, with a minimum one-year follow-up, defined clinical and radiographic outcome criteria and estimable success rate for endodontic-periodontal lesion were included. Statistical analysis was performed using OpenMeta[Analyst] software. Results: Of a total of 113 articles, 34 were selected for full-text reading after duplicates deletion and title and abstract analysis. Thirteen and six studies were included in the systematic review and meta-analysis, respectively. A total of 2775 pooled teeth were submitted to EMS, of which 492 teeth and 4 roots had periodontal involvement. According to the qualitative analysis, success rates of the endodontic-periodontal group ranged from 67.6% to 88.2%. Meta-analysis revealed that the absence of periodontal attachment loss was predictive of a higher likelihood of success with an odds ratio of 3.14. Conclusions: Periodontal attachment loss presents a risk factor for EMS outcome. Although endodontic-periodontal lesions were associated with lower success rates considering a 1 to 10 years follow-up period, long-term successful prognosis following EMS has been reported, therefore presenting a fully valid and viable therapeutic option for the management of this type of lesions.

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

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

Intentional replantation to the endodontic-periodontal disease associated with misplacement of a rubber band-like foreign body: A case report

The authors report a case of severe periodontal destruction and subsequent pulp necrosis. Intentional replantation was performed to treat and investigate of the cause of this idiopathic, rapidly progressive, endodontic-periodontal lesion. A rubber band-like foreign body was incidentally discovered in the periodontal tissue. Although dislocation of a foreign body during dental treatment is unusual, it may happen occasionally. Careful oral examination is recommended, and a fissure-like deep crease in the free gingiva may be helpful in diagnosing misplacement of a foreign body in the periodontal tissue.

Platelet-Rich Fibrin: A Viable Therapy for Endodontic-Periodontal Lesions? A Preliminary Assessment

Background and Objectives: The endodontic system and the periodontium are closely interrelated and the infection of both leads to the appearance of endodontic-periodontal lesions. Along with the endodontic and periodontal classic treatment, in most cases, there is a need for regenerative periodontal therapy for the repair of the damaged tissue. One material that stimulates bone healing is represented by platelet-rich fibrin (PRF). The aim of this study was to determine if the inclusion of PRF in the treatment protocol of endodontic-periodontal lesions is effective. Materials and Methods: This review was conducted according to the PRISMA guidelines. Four databases, MEDLINE (through PubMed), Scopus, Web of Science, and Google Scholar, were used in order to find all significant articles on the topic. Relevant keywords were used in different combinations. Results: The inclusion criteria were met by six studies, published between 2014 and 2020 and they were selected for the review. The use of PRF for the regenerative therapy of endodontic-periodontal lesions showed favorable outcomes in all of the studies included, with significant reductions in the probing depths. Conclusion: While platelet-rich fibrin may be beneficial, further research is needed.

Successful management of mandibular first molars with endodontic-periodontal lesions – Two case reports

The interrelationship between pulpal and periodontal disease primarily occurs through the intimate anatomic and vascular connections between the pulp and the periodontium. The purpose of this case report is to present the treatment of two cases of mandibular first molars displaying endodontic-periodontal lesions with and without the use of regenerative bone techniques. The endodontic treatments were performed under an operating microscope in two appointments. Later, periodontal therapy was performed with a non-surgical approach in one case and with guided bone regeneration in the other. A 12-month radiographic and clinical follow-up showed periapical and periodontal healing in both cases. The present case report demonstrates that an interdisciplinary approach can help improve the prognosis and maintain natural dentition. Moreover, periodontal regenerative therapy can be performed to guide the wound healing towards the regeneration of lost periodontal structures.

Regenerative Therapy Modality for Treatment of True Combined Endodontic-Periodontal Lesions: A Randomized Controlled Clinical Trial.

The aim of this in-vivo study was to evaluate/compare the clinical periodontal parameters in patients with true combined endo-perio lesions (EPL), treated with gutta-percha (GP) and mineral trioxide (MTA) as an obturation material alone and with addition of bone grafting in such lesions. 120 Saudi patients (mean age = 41yrs) diagnosed with true combined EPL participated in this study. Group I (control group, n = 30) was treated with conventional endodontic treatment using GP for obturation. Group II (n = 30) was treated with conventional endodontic treatment using MTA for obturation. Group III (n = 30) was treated with conventional endodontic treatment using GP for obturation + grafting procedure to fill the bony defect. Group IV (n = 30) was treated with conventional endodontic treatment using MTA for obturation + grafting procedure to fill the bony defect. Clinical parameters (Pocket depth (PD); Clinical attachment loss (CAL); keratinized tissue width (KTW); gingival phenotype (G.Ph.) and Cone Beam Computed Tomography Periapical Index (CBCTPAI)) were recorded and compared at baseline, 3, 6, 12 months’ interval. For the groups III and IV, CBCTPAI showed significant difference (p < 0.0001) with the other groups at 6 months and 1-year interval. The group with MTA + bone graft showed 76% and 90% patients with 0 score at 6 months and 1-year follow-up, respectively. Comparison of mean values of PD among study groups at 3 months, 6 months and 1 year showed significant difference at 3 months, whereas the mean PD values of subjects in GP + bone graft showed significantly higher PD values than other 3 groups (p = 0.025). Use of GP and MTA for root canal obturation along with periodontal therapy and bone augmentation helps in resolving complex endo-perio lesions. Bone grafting in addition to obturation with MTA was found to be the best treatment strategy in management of EPL cases and is recommended for clinicians who are treating EPL patients.

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

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

Unusual Ludwig´s angina in systemic disabled patient related with periodontal disease

The Ludwig's angina is an infectious process involving submandibular, sublingual, and submental spaces bilaterally. They can rapidly progress to airway obstruction and hemodynamic instability. The most common cause of Ludwig's angina is apical dental infections, specifically involving the roots of second and third mandibular molars, which are contiguous to the submandibular space. Periodontal diseases are related with bone loss around dental roots and create a situation where the inflammatory drainage tends to assume a sulcular direction. The purpose of this article is to report a clinical patient with an unusual development of a periodontic-endodontic lesion leading to Ludwig's angina in patient whit diabetics, hypertension and chronic kidney disease. Thus, we can conclude that even if it is not common reports of angina associated with periodontal diseases we must attend to patient's correct care, initiating antibiotic therapy, maintenance of the airways, removal of infectious focus and control of comorbidities diseases.

Treatment of a tooth with furcation involvement and extensive alveolar bone resorption due to endodontic-periodontal combined lesion using root resection: a case report

Treatment of a tooth with furcation involvement and extensive alveolar bone resorption due to endodontic-periodontal combined lesion using root resection: a case report

Effects of hyaluronic acid and deproteinized bovine bone mineral with 10% collagen for ridge preservation in compromised extraction sockets.

The aim of this study was to evaluate the efficacy of deproteinized bovine bone mineral with 10% collagen (DBBM-C) soaked with hyaluronic acid (HA) for ridge preservation in compromised extraction sockets. Bilateral third, fourth premolars and first molar were hemisected, distal roots were extracted, and then combined endodontic periodontal lesion was induced in the remaining mesial roots. After 4 months, the mesial roots were extracted and the following four treatments were randomly performed: Absorbable collagen sponge (ACS), ACS soaked with HA (ACS+HA), ridge preservation with DBBM-C covered with a collagen membrane (RP), ridge preservation with DBBM-C mixed with HA and covered with a collagen membrane (RP+HA). Animals were sacrificed at 1 and 3 months following treatment. Ridge dimensional changes and bone formation were examined using microcomputed tomography, histology, and histomorphometry. At 1 month, ridge width was significantly higher in the RP and RP+HA groups than in the ACS and ACS+HA groups, while the highest proportion of mineralized bone was observed in ACS+HA group. At 3 months, ridge width remained significantly higher in the RP and RP+HA groups than in the ACS and ACS+HA groups. ACS+HA and RP+HA treatments featured the highest proportion of mineralized bone and bone volume density compared with the other groups. No statistical difference was observed between ACS+HA and RP+HA treatments. Ridge preservation with the mixture DBBM-C/HA prevented dimensional shrinkage and improved bone formation in compromised extraction sockets at 1 and 3 months.

Palatal-root Resection in Endodontic–Periodontal Combined Lesions - A Case Report

Endodontic-periodontal combined lesion is a clinical dilemma because establishing a differential diagnosis and predicting a prognosis are difficult. A correct diagnosis is sometimes difficult; an accurate knowledge of the etiologic factors is essential for adequate choice of treatment. The management of endodontic-periodontal combined lesion demands both endodontic and periodontal therapy. Root resection therapy is one treatment option for preserving multirooted tooth with furcation involvement. This case report reviews root resective therapy and the concomitant endodontic management as a treatment option for an endo-periodontal lesion in periodontitis patients in maxillary molar. The role of root resection and treatment strategy are also discussed based on a review of the endodontic and periodontal literature.

Mandibular First Premolar with Three Canals and Periodontalendodontic Lesion: Case Report

This clinical report presents and describes both the endodontic and periodontal treatment of a mandibular first premolar exhibiting three root canals presented with perio-endo infection. Mandibular first premolars usually have a single root and a single root canal. The incidence of three root canals in this tooth is quite rare. Knowledge of root canal morphology, proper clinical examination, correct radiographic interpretation, using dental operating microscope, and careful tactile examination of the root canals are important in detecting the presence of the multiple canals and in treating the endodontic and periodontal lesions.

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&lt;0.05). It was verified that 65.4% of the teeth were diagnosed with a primary endodontic lesion and that the periodontal component was present in 34.6% of the teeth, either in a primary (10.6%), secondary (11.5%), or combined form (12.5%). True combined endodontic-periodontal lesion occurred significantly in molar teeth compared to non-molar teeth (p&lt;0.05). Conclusion The primary endodontic lesion was found in a greater proportion in teeth referred for endodontic treatment; however, approximately 1/3 of the sample had periodontal involvement, which demonstrates the importance of the periodontal examination together with the general clinical examination.

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.