Endodontic-Periodontal Lesions Service evaluation of endodontic-periodontal lesions with or without root damage diagnosis and treatment planning based on clinical and radiographic findings

Abstract

Aims: Endo-perio lesions (EPLs) are pathological communications between the pulpal and periodontal tissues of a tooth. These lesions can present in either an acute (symptomatic) or chronic (asymptomatic) form and are classified based on their signs and symptoms, which directly influence their prognosis and treatment options. The purpose of the current service evaluation is to 1) describe the clinical and radiographic characteristics of EPLs at the initial assessment based on the 2017 World Workshop (WWP) classification, 2) to assess the agreement between the clinical and radiographic assessment using Periapical (PA) radiograph and Cone-beam Computed Tomography (CBCT) scans, 3) to determine the care planning based on the WWP diagnosis, and 4) to examine whether there is an association between the 2017 WW classification and care planning pathways. Methods: The service evaluation was conducted from March 2022 to November 2023 for patients referred from the periodontal new patient consultation clinic at Guy’s Hospital, London, UK. Based on the diagnosis following clinical and radiographical assessment, the care management options were extracting teeth with a hopeless prognosis or proceeding with one of the following treatment pathways: including 1) endodontic treatment followed by non- surgical periodontal therapy (NSPT) alone or 2) endodontic treatment, NSPT, periodontal review and pocket reduction surgical procedures; 3) endodontic treatment followed by root resection or hemisection 4) vital root resection. For teeth with a normal response to sensibility tests, the possible treatment pathways are periodontal non-surgical therapy followed by pocket reduction surgery or vital root resection Results: 61 teeth were included, 34 teeth were classified as grade 3 EPL in periodontitis patients without root damage. 51% of teeth showed a negative response to sensibility testing, Radiographic examination showed distinct periapical radiolucency in 40% of teeth and 41% of the lesions are extended beyond the apical 1/3 of the root. The most frequent treatment pathway for the referred cases was tooth extraction (22 teeth), while, 39 teeth were salvageable via treatments through different care planning pathways. There were no significant differences between the CBCT vertical alveolar bone height compared to CAL. A moderately weak and significant correlation was found between EPL grading with CBCT circumferential bone loss. In terms of the association between the 2017 WW classification 3 and the possible care planning pathways, our data failed to identify a distinction between care planning for cases diagnosed with EPL grade II and grade III. Conclusions: The service evaluation reinforced the importance of comprehensive clinical and radiographical investigations in the management of these complex EPLs. Despite the poor prognosis of the teeth diagnosed with EPL, most of these may be salvageable by good care planning.