Assessment and management of endo-periodontal lesions Philippa Hoyle Manoj Tank Somayeh Modarres-Simmons Claire Annabel Storey Dental Update 2024 46:10, 707-709.
Authors
PhilippaHoyle
BChD(Hons), MJDF RCS(Eng), MPros RCS(Ed)
Consultant in Restorative Dentistry, Department of Restorative Dentistry, Charles Clifford Dental Hospital, 76 Wellesley Road, Sheffield S10 2SZ, UK (philippahoyle1@hotmail.co.uk)
Endo-periodontal lesions present a number of challenges for clinicians. These include understanding their underlying aetiology, forming an accurate diagnosis and suitable prognosis and subsequently formulating an effective treatment strategy. This article aims to provide a summary of the literature available in the areas highlighted above, with particular reference to the recent joint American Academy of Periodontology and European Federation of Periodontology (AAP/EFP) world workshop for classification of periodontal and peri-implant diseases.
CPD/Clinical Relevance: This paper outlines important aspects a clinician must consider, including anatomy, a systematic methodology for assessment and introduction of the new classification of periodontal diseases in diagnosis. Prognosis and formulation of appropriate management strategies are explored.
Article
The new classification of periodontal and peri-implant diseases has retained the recognition of endo-periodontal lesions (EPLs) as a separate disease classification, due to the known pathophysiological differences from periodontitis, especially in the acute form, which includes its rapid onset and tissue destruction, as well as symptomatic presentation to the clinic.1
In general dental practice, there can be confusion unpicking the signs and symptoms in patients presenting with an EPL. Part of this uncertainty is deciphering whether the infection is endodontic or periodontal in origin. In all EPL cases, whether acute or chronic, there is a pathological communication between the periodontal and pulpal tissues, thereby resulting in more complex and challenging management. The anatomical variations in root canal morphology internally, including the presence of accessory and lateral canals and intricacy of the periodontium externally, provide challenging conditions for diagnosing and controlling bacterial infections. EPLs significantly negatively affect the prognosis of a tooth and present challenges for management, involving multiple treatment modalities.2
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