Endodontic-Periodontal Lesions: Periodontal Aspects

Periodontal-endodontic lesions are the combination of pulp involvement and periodontal disease in the same tooth. Diagnosis may become difficult; however, a differential etiological consideration is indispensable for appropriate treatment. Cases with endodontic-periodontal lesions usually present with several clinical and radiological features, such as altered response to testing of pulp sensitivity, clinical signs of gingival inflammation, increased probing pocket depth, sinus tracts, pus secretion and different types of radiological bony defects, several areas of the dentition show periodontal involvement, all of which difficult the diagnosis of the primary cause. According to their main initial etiology, periodontal-endodontic lesions may be classified as: 1.Purely periodontal lesion-when a deep periodontal lesion involves most of the root surface, and the dental pulp is vital. 2.Purely endodontic lesion-when the pulp is necrotic and infected, and there is a draining sinus tract coronally through the periodontal ligament into the gingival sulcus. 3.Endodontic-periodontal lesion-when the pulp is necrotic and infected, and there is a deep periodontal pocket. An accurate prognosis is most critical when periodontal and endodontic therapy are combined with large oral prosthetic rehabilitation or with dental implants; in these complex cases, an accurate long-term prognosis of the involved teeth must be established at the time of treatment planning. Oral implants do not surpass the long-term longevity of teeth, even if periodontal or endodontic problems are present.