Endodontic-periodontal microsurgery for combined endodontic-periodontal lesions: An overview

Abstract

Endodontic and periodontal microsurgery has surpassed the success rates for traditional endodontic and periodontal surgical procedures. Excellent healing results are being attributed to both the techniques, when employed, for isolated endodontic or periodontal defects. Combined endodontic-periodontal lesions have been referred to as a true challenge, requiring not only endodontic microsurgical management but also concurrent bone grafting and membrane barriers techniques. The prevention of epithelial downgrowth and regeneration of periodontal cementum, fiber, and bone seals the fate of these cases. Achieving primary closure with submergence of grafts has a positive effect on GTR outcome. New techniques of periodontal microsurgery, such as minimally invasive papilla preserving flaps with passive internal mattress suturing, have managed to obtain 90% primary flap closure over grafted sites. Root surface treatment and conditioning has also shown to be beneficial for GTR. Endodontic microsurgery for the combined lesion has not integrated these advances yet. These advances, along with a recently suggested treatment strategy, are ushering in the level next in management of the combined lesions. This article offers an overview of the combined lesion, the disease, its classification, treatment strategy, regenerative tools, microsurgical recommendations, and outcome studies.

Healing of an Advanced Endo-Perio Lesion after Sole Endodontic Therapy

“…The most common clinical/radiographic features of the endodontic-periodontal lesions reported were the periapical radiolucency and deep pocket with a nonvital pulp status. Guided tissue regeneration (GTR) is strongly indicated in cases with a communication of periodontal pocket with periapical lesions, compromised bifurcation or trifurcation crests, and dehiscence with buccal or lingual bone loss [21,22]. However, healing in the present case took place without any periodontal intervention.…”

Tratar ou extrair? Tratamento de lesão endoperiodontal, um relato de caso clínico

“…Existem outras terapias que estão sendo propostas na literatura que podem ser empregadas, dependendo da gravidade de cada caso, como alternativa à terapia periodontal básica, visando o tratamento desse tipo de lesão, contribuindo para o aumento das taxas de sucesso 28 , como a regeneração tecidual guiada [29][30][31] , utilizando, por exemplo, fibrina rica em plaquetas leucocitárias 2 , o manejo microcirúrgico endodôntico e periodontal, o enxerto ósseo e as técnicas de barreira de membrana 32,33 , além da irradiação com laser de diodo 34 , o manejo do defeito de furca com vidro bioativo 35 e enxerto de tecido conjuntivo subepitelial com periósteo 36 . Sendo que, atualmente, também estão sendo utilizados kits de detecção de bactérias produtoras de peptidase para verificar a diminuição de bactérias na furca e canais radiculares 37 .…”

Multidisciplinary management of concomitant pulpal and periodontal lesion: A case report

“…The combined endodontic-periodontal lesions were investigated; thus, different treatment strategies were described 6, 7, 8. Oh et al.…”