Keywords
Endoperiodontal lesions
Tissue regeneration
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Abstract
Objective: To review the classification, diagnosis, and therapeutic management of endoperiodontal lesions, emphasizing imaging methods, biomarkers, biomaterials, and regenerative strategies. Literature review: The current classification of endoperiodontal lesions (EPL) considers the presence or absence of root damage and, in cases without damage, the presence of periodontitis and the extent of periodontal involvement. Cone-beam computed tomography (CBCT) and inflammatory biomarkers may complement clinical assessment in selected cases. When pulpal necrosis or endodontic infection is present, endodontic treatment generally precedes or is integrated with periodontal therapy. MTA, bioceramic cements, guided tissue regeneration, platelet concentrates, and photobiomodulation show potential as adjunctive resources. Final considerations: Accurate classification and integrated assessment of pulpal and periodontal tissues are fundamental to treatment planning. Diagnostic technologies, biomaterials, and regenerative therapies may contribute to management, but heterogeneous evidence still limits protocol standardization.
References
AL-FOUZAN KS. A new classification of endodontic-periodontal lesions. International Journal of Dentistry, 2014; 2014: 919173.
AL-SIBASSI A, et al. Management of the endodontic-periodontal lesion. British Dental Journal, 2025; 238(7): 536-544.
ARDILA CM, VIVARES-BUILES AM. Clinical efficacy of treatment of endodontic-periodontal lesions: a systematic scoping review of experimental studies. International Journal of Environmental Research and Public Health, 2022; 19(20): 13649.
ATIA GAN, et al. Advances in bioceramic silicates for therapeutic, and regenerative dentofacial reconstruction. Ceramics International, 2024; 50(13): 22184-22208.
BHARUKA T, RECHE A. Advancements in periodontal regeneration: a comprehensive review of stem cell therapy. Cureus, 2024; 16(2): e54115.
CASTELO-BAZ P, et al. Combined endodontic-periodontal treatment of a palatogingival groove. Journal of Endodontics, 2015; 41(11): 1918-1922.
CERVINO G, et al. Mineral trioxide aggregate applications in endodontics: a review. European Journal of Dentistry, 2020; 14(4): 683-691.
CHEN B, et al. Expert consensus on the diagnosis and therapy of endo-periodontal lesions. International Journal of Oral Science, 2024; 16(1): 55.
CORTELLINI P, et al. Periodontal regeneration versus extraction and dental implant or prosthetic replacement of teeth severely compromised by attachment loss to the apex: a randomized controlled clinical trial reporting 10-year outcomes, survival analysis and mean cumulative cost of recurrence. Journal of Clinical Periodontology, 2020; 47(6): 768-776.
DAKÓ T, et al. Endo-perio lesions: diagnosis and interdisciplinary treatment options. Acta Stomatologica Marisiensis Journal, 2020; 3(1): 257-261.
DONG X, XU X. Bioceramics in endodontics: updates and future perspectives. Bioengineering, 2023; 10(3): 354.
ELSAID SF, et al. Assessment of cone beam computed tomography scans referral reasons and its impact on modifying treatment plan in endodontics. Alexandria Dental Journal, 2023; 48(3): 70-76.
FAN X, et al. Prognostic factors of grade 2-3 endo-periodontal lesions treated nonsurgically in patients with periodontitis: a retrospective case-control study. BioMed Research International, 2020; 2020: 1592910.
GONTU S, et al. Prostho perio endo interdisciplinary clinical approach - a review. University Journal of Dental Sciences, 2023; 9(4): 82-89.
GUO J, et al. Prognostic factors of combined periodontal and endodontic lesions: a retrospective study. Contrast Media & Molecular Imaging, 2022; 2022: 5042097.
GUPTA S, et al. Effect of time lapse between endodontic and periodontal therapies on the healing of concurrent endodontic-periodontal lesions without communication: a prospective randomized clinical trial. Journal of Endodontics, 2015; 41(6): 785-790.
HERRERA D, et al. Acute periodontal lesions (periodontal abscesses and necrotizing periodontal diseases) and endo-periodontal lesions. Journal of Clinical Periodontology, 2018; 45(Suppl 20): S78-S94.
HERRERA D, et al. Treatment of stage IV periodontitis: the EFP S3 level clinical practice guideline. Journal of Clinical Periodontology, 2022; 49(Suppl 24): 4-71.
LI L, et al. Comparison of dental pulp periodontal therapy and conventional simple periodontal therapy as treatment modalities for severe periodontitis. World Journal of Clinical Cases, 2021; 9(33): 10098-10105.
LU B, et al. Expression of interleukin-1β and matrix metalloproteinase-8 in cytolytic and noncytolytic Enterococcus faecalis-induced persistent apical periodontitis: a comparative study in the rat. Journal of Endodontics, 2015; 41(8): 1288-1293.
LUCHIAN I, et al. The role of matrix metalloproteinases (MMP-8, MMP-9, MMP-13) in periodontal and peri-implant pathological processes. International Journal of Molecular Sciences, 2022; 23(3): 1806.
MIAO H, et al. Papillary reconstruction and guided tissue regeneration for combined periodontal-endodontic lesions caused by palatogingival groove and additional root: a case report. Clinical Case Reports, 2015; 3(12): 1042-1049.
MOHAN SP, et al. Platelet-rich plasma and platelet-rich fibrin in periodontal regeneration: a review. Journal of Pharmacy & Bioallied Sciences, 2019; 11(Suppl 2): S126-S130.
NAVALEGUNDA PS, KESHAVA PRASAD BS. Bioceramic materials: a review. International Journal of Science and Research, 2023; 12(6): 1620-1625.
OUCHI T, NAKAGAWA T. Mesenchymal stem cell-based tissue regeneration therapies for periodontitis. Regenerative Therapy, 2020; 14: 72-78.
PATIL BA, SHAKEEL S. Evaluation of endo perio lesions using cone beam computed tomography (CBCT) - a cross sectional study. International Journal of Periodontics & Restorative Dentistry, 2023; 43(7): 235-243.
REZENDE TMB, et al. Mineral trioxide aggregate (MTA) inhibits osteoclastogenesis and osteoclast activation through calcium and aluminum activities. Clinical Oral Investigations, 2021; 25(4): 1805-1814.
ROTSTEIN I. Interaction between endodontics and periodontics. Periodontology 2000, 2017; 74(1): 11-39.
RUBIO F, et al. Photobiomodulation therapy and endodontic treatment of teeth with apical periodontitis using 940-nm diode laser: report of two cases. Journal of Clinical and Experimental Dentistry, 2022; 14(3): e298-e302.
RUBIO F, et al. Antimicrobial photodynamic therapy combined with photobiomodulation therapy in teeth with asymptomatic apical periodontitis: a case series. Applied Sciences, 2024; 14(20): 9341.
RUETTERS M, et al. Effect of endodontic treatment on periodontal healing of grade 3 endo-periodontal lesions without root damage in periodontally compromised patients: a retrospective pilot study. Clinical Oral Investigations, 2021; 25(4): 2373-2380.
SABETI M, et al. Histopathological investigation of dental pulp reactions related to periodontitis. European Endodontic Journal, 2021; 6(2): 164-169.
SANZ M, et al. Treatment of stage I-III periodontitis: the EFP S3 level clinical practice guideline. Journal of Clinical Periodontology, 2020; 47(Suppl 22): 4-60.
TIETMANN C, et al. Management of teeth with grade 3 endo-periodontal lesions by combined endodontic and regenerative periodontal therapy. Journal of Clinical Medicine, 2024; 13(1): 93.
TONETTI MS, et al. Staging and grading of periodontitis: framework and proposal of a new classification and case definition. Journal of Clinical Periodontology, 2018; 45(Suppl 20): S149-S161.
TORABINEJAD M, et al. Regenerative endodontic treatment or mineral trioxide aggregate apical plug in teeth with necrotic pulps and open apices: a systematic review and meta-analysis. Journal of Endodontics, 2017; 43(11): 1806-1820.
YAPP KE, et al. Periapical radiography versus cone beam computed tomography in endodontic disease detection: a free-response, factorial study. Journal of Endodontics, 2023; 49(4): 419-429.
ZAHARESCU A, et al. Etiopathogenic molecular mechanisms in the development of endo-periodontal lesions. Romanian Journal of Medical and Dental Education, 2019; 8(4): 14-21.