Treatment of periodontal-endodontic lesions--a systematic review

Abstract

Background: The treatment of periodontal-endodontic lesions is challenging due to the involvement of both periodontal and endodontic tissues.

Objective: To evaluate the treatment options and outcomes of periodontal-endodontic lesions.

Material and methods: A systematic literature search was performed for articles published by 12 May 2013 using electronic databases and hand search. Two reviewers conducted the study selection, data collection and validity assessment. The PRISMA criteria were applied. From 1087 titles identified by the search strategy, five studies and 18 case reports were included.

Results: Clinical studies and case reports were published from the years 1981 to 2012. A pronounced heterogeneity exists among studies regarding applied treatment protocols and quality of reporting. In all clinical studies, comprising 111 teeth, a non-surgical root canal treatment (RCT) was performed as initial treatment step. Non-surgical and/or a surgical periodontal therapy was applied in some studies without re-evaluation of the endodontic healing. Probing pocket depth reductions were reported in all included studies, comprising the data from 80 teeth at follow-up.

Conclusions: A sequential treatment with root canal treatment as a first treatment step appears to be reasonable. An adequate time for tissue healing is suggested prior to re-evaluation.

Keywords: periodontal surgery; periodontitis; pulp necrosis; root canal treatment.