A New Classification of Endodontic-Periodontal Lesions

Abstract

The interrelationship between periodontal and endodontic disease has always aroused confusion, queries, and controversy. Differentiating between a periodontal and an endodontic problem can be difficult. A symptomatic tooth may have pain of periodontal and/or pulpal origin. The nature of that pain is often the first clue in determining the etiology of such a problem. Radiographic and clinical evaluation can help clarify the nature of the problem. In some cases, the influence of pulpal pathology may cause the periodontal involvement and vice versa. The simultaneous existence of pulpal problems and inflammatory periodontal disease can complicate diagnosis and treatment planning. An endo-perio lesion can have a varied pathogenesis which ranges from simple to relatively complex one. The differential diagnosis of endodontic and periodontal diseases can sometimes be difficult, but it is of vital importance to make a correct diagnosis for providing the appropriate treatment. This paper aims to discuss a modified clinical classification to be considered for accurately diagnosing and treating endo-perio lesion.

Investigations of the prevalence and virulence of Candida albicans in periodontal and endodontic lesions in diabetic and normoglycemic patients

“…Moreover, it may be attributed to increased adhesion of fungi in epithelial cells facilitated by increased glucose content in saliva, genetic susceptibility to infection, changes in defense mechanisms, and changes in local factors, including disadvantaged blood support 1 .…”

Acute periodontal lesions (periodontal abscesses and necrotizing periodontal diseases) and endo‐periodontal lesions

“…and included the following categories: (1) primary endodontic lesions; (2) primary endodontic lesions with secondary periodontal involvement; (3) primary periodontal lesions; (4) primary periodontal lesions with secondary endodontic involvement; and (5) “true” combined lesions. The main drawback of this classification and a recent proposed amendment was to base their categories on the primary source of infection (root canal or periodontal pocket). This seemed to be a suitable approach, as lesions of periodontal origin might have a worse prognosis than those of endodontic origin.…”

“…time, the 1999 classification system for Periodontal Diseases and Conditions118,121 included the EPLs, which were described under Section VII -Periodontitis Associated with Endodontic Lesion, as a single category entitled "Combined Periodontal-Endodontic Lesions." An advantage of this classification over the previous ones89,117 was that it reflected the current clinical condition of the lesion, thereby overcoming the problem of using "history of the disease" as the main criteria. Nonetheless, the following problems were associated with this classification system: (1) grouping all EPL under a single section entitled "Periodontitis Associated with Endodontic Lesion" was not ideal, as these lesions may occur in subjects with or without periodontitis; (2) the single category presented, "Combined Periodontal-Endodontic Lesions", was too generic and not sufficiently discriminative to help the clinician to determine the most effective treatment for a particular lesion.…”

Bioactive injectable aggregates with nanofibrous microspheres and human dental pulp stem cells: A translational strategy in dental endodontics

“…One of the most important issues in dental tissue engineering is the search for suitable biomaterials and stem cell populations that allow the construction of new tissues for dental therapeutic needs. Several dental pathologies may affect the functionality of the pulp–dentin complex, including trauma, caries, necrosis and chronic dental pulp inflammation (Al‐Fouzan, ); in addition, bacterial colonization or dental trauma may lead to permanent damage of mineralized and non‐mineralized dental tissues. In these cases, inflammation can affect the dental pulp and pulpitis or necrosis may occur, leading to odontoblast cell death.…”