Clinical Efficacy of Treatment of Endodontic-Periodontal Lesions: A Systematic Scoping Review of Experimental Studies

Abstract

Background: In this review, we evaluated the clinical efficacy of interventions used for the treatment of endo-perio lesions (EPL). Methods: A systematic scoping review of clinical trials was developed. Results: Seven clinical trials were studied. In at least one study group of six of the seven evaluated trials, endodontic and periodontal treatments were performed simultaneously. All trials showed improvement in probing depth in the studied groups; nevertheless, the experimental groups of five studies demonstrated a statistically significant reduction in this parameter. An increase in clinical attachment level was also reported (p < 0.05). Most trials reported an increase in the filling of the bone defect following therapy (p < 0.05). Mechanical periodontal therapy implemented simultaneously with endodontic therapy demonstrated efficacy in the treatment of concurrent EPL without communication. Endodontic treatment and immediate periodontal surgery did not affect the result of the management of combined EPL with apical communication. The use of diode laser, the management of platelet-rich fibrin (PRF) and titanium-prepared PRF, and the implementation of bone grafts plus endodontic treatment with mineral-trioxide or gutta-percha seems to be an adequate strategy in patients with EPL. Conclusions: The treatment of EPL using simultaneous endodontic and periodontal therapies seems to be an acceptable treatment alternative.

A retrospective study on the prognostic factors and success, survival, and failure outcomes of treated endodontic‐periodontal lesions

“…Another systematic review by Oktawati et al ( 2020 ) found that every study exhibited an improvement in probing depths, although it is notable that all were case studies. A systematic review of clinical trials by Ardila and Vivares‐Builes (Ardila & Vivares‐Builes, 2022 ) found that five out of seven studies (71.4%) had an improvement in probing depths, which is similar to the combined success and survival rate of the current study. Other studies had improved outcomes, such as Oh et al ( 2019 ), who found a 5‐year survival rate of 92.31%, and Kim et al ( 2008 ), who found a success rate of 77.5% with a minimum 1‐year follow‐up.…”

“…A systematic review of treatment modalities by Schmidt et al ( 2014 ) found possible evidence that initial endodontic treatment results in superior outcomes. Another systemic review by Ardila and Vivares‐Builes (Ardila & Vivares‐Builes, 2022 ) found that most studies treated EPLs with simultaneous endodontic and periodontal treatment, with a majority resulting in a statistically significant improvement in probing depths. Recent studies have focused on modern treatment advancements such as guided bone regeneration and incorporating platelet‐rich fibrin, which have both exhibited success in periodontal healing and attachment gain (AlJasser et al, 2021 ; Makkad, 2023 ).…”

Endo-Perio Lesions and Dentists’ Treatment Approach: A Survey

“…However, there have been controversial reports on the optimum sequence and timing of RCT and PT of combined EPLs [17]. Ardila and Builes suggested simultaneous RCT and PT of EPLs [18]. However, when the root canals are infected, some researchers suggest performing RCT before any PT, to eliminate the intracanal infection before any cementum is removed [12].…”

Efficacy of Periodontal Endoscopy during Subgingival Debridement to Treat Periodontitis: A Systematic Review of Randomized Clinical Trials

“…This disease is characterized by the destruction of the supporting tissues of the tooth that can eventually cause tooth loss and results from a complex interplay between the subgingival biofilm and the host response [1]. Thus, host reactions regulate most of the tissue destruction that leads to the clinical expressions of the disease [2]. Plaque biofilm has a primary and gradual role in periodontal disease where mineralization into calculus turns as a holding device for non-calcified plaque, offering ideal settings for microorganisms to colonize and metabolize, thereby hindering periodontal therapy [2,3].…”

“…Thus, host reactions regulate most of the tissue destruction that leads to the clinical expressions of the disease [2]. Plaque biofilm has a primary and gradual role in periodontal disease where mineralization into calculus turns as a holding device for non-calcified plaque, offering ideal settings for microorganisms to colonize and metabolize, thereby hindering periodontal therapy [2,3]. Therefore, successful programs for the timely diagnosis and treatment of periodontitis may be pertinent to restricting the systemic damage that this disease can cause [2].…”