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

The impact of personalized postoperative care plan on the compliance and long-term efficacy of minimally invasive periodontal surgery treatment recommendations

PURPOSE

Periodontal disease significantly affects oral health and contributes to adult tooth loss worldwide. Minimally invasive periodontal surgery (MIPS) aims to enhance outcomes while reducing postoperative discomfort. The efficacy of such surgeries largely depends on postoperative care. This study evaluates the effect of personalized postoperative care plans on patient compliance and outcomes compared to standard care.

DESIGN AND METHODS

A retrospective cohort study was conducted involving 118 patients who underwent MIPS between April 2022 and March 2024. Patients were divided into a control group receiving standard care (n = 67) and an intervention group receiving personalized care (n = 51). Procedures included structured assessments of compliance, gingival health, pain, anxiety, depression, and satisfaction using validated scales.

FINDINGS

Post-intervention, the personalized care group showed significantly improved gingival indices (BI, PLI, GI, SBI), compliance scores, and curative effect rates (p < 0.05). Pain (VAS score) and sensitivity were reduced (p < 0.05), alongside significant decreases in anxiety (SAS) and depression (SDS) scores (p < 0.01). Patient satisfaction rates were higher in the intervention group, with greater reports of 'very satisfied' experiences (p = 0.006). OHIP-14 scores indicated improved oral health quality in the personalized care group (p < 0.01).

CONCLUSION

Personalized care enhances compliance and long-term efficacy of MIPS through tailored interventions addressing individual patient needs, leading to improved clinical and psychosocial outcomes.

Endodontic Regeneration Therapy: Current Strategies and Tissue Engineering Solutions

With increasing life expectancy and an aging population, the demand for dental treatments that preserve natural teeth has grown significantly. Among these treatments, endodontic therapies for pulpitis and apical periodontitis play a vital role, not only in keeping occlusal function, but also in preventing the exacerbation of systemic diseases. Both pulpitis and apical periodontitis are primarily caused by infections of the oral pathobiont within the root canal, leading to inflammation and destruction of the pulp, apical periodontal tissue, and bone. Standard root canal therapy aims to remove the infection source and facilitate natural tissue healing through the body's regenerative capacity. However, challenges remain, including limited tooth functionality after complete pulp removal in pulpitis and insufficient recovery of the large bone defect in apical periodontitis. To address these limitations, endodontic regenerative therapies have emerged as promising alternatives. Pulp regeneration therapy seeks to restore the functionality of dental pulp, while bone regeneration therapy aims to repair and regenerate large bone defects affected by apical periodontal tissue.

Endodontic surgery and platelet concentrates: A comprehensive review

While autologous platelet concentrates (APCs) have gained traction as promising regenerative materials in recent years, their impact on wound healing and tissue regeneration in periapical hard tissue defects remains controversial. Endodontic microsurgery (EMS) has embraced the potential of platelet concentrates, particularly L-PRF (Leucocyte-Platelet-Rich Fibrin) and PRP (Platelet-Rich Plasma), as regenerative tools. These concentrates, rich in growth factors and other bioactive molecules, are thought to enhance healing and treatment outcomes for various endodontic conditions. However, their effectiveness remains a subject of investigation. Despite encouraging 3-D cone beam computed tomography (CBCT) based evidence for PRP's effectiveness in complex lesions and apico-marginal defects, inconsistencies in its performance across preparation and application protocols raise questions about its superiority over existing options. More research is crucial to understand its full potential as a reliable regenerative tool in endodontics. L-PRF and its derivatives are particularly effective in treating apical-marginal defects. It enhances clinical attachment levels and reduces probing pocket depths, likely due to its slow and coordinated release of various growth factors. L-PRF has been shown to also improve patients' quality of life by reducing postoperative swelling and pain. However, more research is needed to standardize its preparation methods and confirm its long-term benefits. This paper aims to provide a comprehensive review of the current knowledge and recent advances in endodontic surgery and the use of platelet concentrates, focusing on their roles in managing periapical lesions and endo-perio lesions.

Knowledge, attitudes, and practices toward the treatment of endodontic-periodontal lesions among oral health care providers: a multi-center cross-sectional study

BACKGROUND

This study aimed to evaluate the knowledge, attitudes, and practices (KAP) of oral healthcare providers concerning the treatment of endodontic-periodontal lesions (EPLs) and investigate the relationships among the KAP dimensions using correlation analysis and structural equation modeling (SEM).

METHODS

This cross-sectional study enrolled dental healthcare professionals between February 2024 and June 2024, with questionnaire data collected in Hangzhou and Shaoxing, China. Data were collected using a self-administered questionnaire that gathered demographic information and KAP scores.

RESULTS

A total of 281 valid questionnaires were analyzed. Among the participants, 185 (70.08%) were doctors, and 58 (59.85%) had attended relevant academic conferences or training sessions. The mean scores for knowledge, attitude, and practice were 10.06 ± 3.31 (possible range: 0-18), 25.58 ± 2.29 (possible range: 7-35), and 15.70 ± 3.23 (possible range: 5-25), respectively. The SEM revealed that education (β = 0.013, P = 0.013), professional title (β = 0.64, P < 0.001), participation in related research projects (β = -1.84, P < 0.001), and number of patients treated (β = 1.41, P < 0.001) directly influenced knowledge. Knowledge (β = 0.24, P < 0.001) and research participation (β = -0.79, P = 0.026) directly affected attitude. Both knowledge (β = 0.26, P < 0.001) and attitude (β = 0.19, P = 0.023) directly impacted practice. Additionally, education (β = 0.23, P = 0.021), professional title (β = 0.15, P = 0.001), research participation (β = -0.44, P = 0.001), and number of patients treated (β = 0.34, P < 0.001) indirectly influenced attitude, while indirect effects on practice were noted for knowledge (β = 0.04, P = 0.034), education (β = 0.30, P = 0.023), professional title (β = 0.20, P = 0.001), research participation (β = -0.73, P < 0.001), and number of patients treated (β = 0.44, P < 0.001).

CONCLUSIONS

Oral healthcare providers demonstrated limited knowledge, generally positive attitudes, and relatively inactive practices in the treatment of EPLs. To enhance clinical outcomes, targeted educational initiatives and hands-on training should be prioritized to address knowledge gaps and facilitate the translation of positive attitudes into more active and effective clinical practices.

Efficacy and inflammatory responses of root canal therapy plus periodontal non-surgical treatment for periodontal-endodontic combined dental lesions

OBJECTIVE

To investigate the efficacy and inflammatory responses of treating periodontal-endodontic combined lesions (PECLs) with root canal therapy (RCT) alone versus RCT combined with periodontal non-surgical treatment (PNST).

METHODS

A total of 103 patients with PECLs admitted between January 2019 and January 2020 to Shenzhen Baoan Women's and Children's Hospital were divided into control (RCT alone, 50 cases) and combined (RCT + PNST, 53 cases) groups. Comparative analyses included efficacy assessment, probing depth (PD), bleeding index (BI), plaque index (PLI), gingival index (GI), serum levels of interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and high-sensitivity C-reactive protein (hs-CRP), pain severity during RCT, incidence of adverse reactions, post-treatment tooth conditions, and recurrence rates at 6 and 12 months. Univariate analysis identified factors associated with poor treatment outcome in PECL patients.

RESULTS

The combined group demonstrated a higher total effective rate (90.57%) compared to the control group (74.00%) (P < 0.05). Patients receiving combined therapy showed significantly lower PD, BI, PLI, GI, IL-1β, TNF-α, and hs-CRP levels, as well as reduced pain severity and lower recurrence rates at 6 and 12 months (all P < 0.05). The combined group also had a lower incidence of adverse (periodontal distending pain and local foreign body sensation) reactions (7.54%) compared to the control group (26.00%) (P < 0.05). After treatment, the incidence of periodontitis, percussion tenderness, and loosening of teeth in the combined group was lower than that of the control group, and the retention rate of affected teeth was significantly higher (all P < 0.05). Factors such as history of alcoholism, betel nut chewing, and treatment method (RCT) were significantly associated with poorer prognosis in PECL patients (P < 0.05).

CONCLUSION

Combined RCT and PNST improves clinical efficacy, reduces pain severity and inflammation levels, decreases adverse reactions, and enhances tooth retention in PECL patients. This treatment approach should be considered the preferred option for managing PECLs.

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

BACKGROUND Endo-perio lesions are a great challenge for dentists. The aim of this study was to evaluate the treatment approach of dental practitioners to endo-perio lesions by considering the current endo-perio classification. MATERIAL AND METHODS An online survey was prepared, consisting of questions about the treatment approach to 3 simulated cases with endo-perio lesions, shown on periapical radiography. Details of the patient's age, presence of systemic disease, smoking, and how the single- or multi-rooted tooth would affect the treatment plan were also included in the simulated cases presented in the survey. The survey was sent to 1500 dentists via e-mail, WhatsApp, and social media platforms. The chi-square test was used for comparison of data. Significance was evaluated at P<0.05. RESULTS In total, 338 dentists participated in the survey, including general dentists, endodontists, and periodontists. Fifty-three percent of participants stated that they would perform root canal treatment and initial periodontal treatment simultaneously, when both treatments were required. In cases classified as grade 3, most general dentists, endodontists, and periodontists answered that they would prescribe systemic antibiotics if there was diffuse extra-oral swelling (P<0.05). Moreover, in grade 3 cases, more general dentists chose the option "extraction" as the best choice, compared with endodontists and periodontists, who did not choose extraction as often (P<0.05). CONCLUSIONS According to the results of this study, general dentists, endodontists, and periodontists generally follow different approaches to endo-perio lesions. A consensus is needed on this issue to develop a successful multidisciplinary approach to endo-perio lesions.

Linking periodontal pathogens with endoperio lesions

Endodontic-periodontal diseases pose difficulties for the practitioner in diagnosing and predicting the success of the affected teeth. Therefore, it is of interest to correlate between periodontal infections and endodontic periodontal disorders. 50 patients of both sexes were included in this study. 28 of the 50 patients were men and 22 were women. Participants with a history of endodontic and periodontal lesions on the same tooth were chosen. A polymerase chain reaction experiment was carried out and relationships were formed. Data shows that isolates of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans and Tannerella forsythia were identified in 91% of the periodontium, 12% of the endodontium, and 51% of the endodontium, respectively. Targeted bacterial species were associated with periodontal and endodontic disorders that occurred concurrently. Therefore, it is plausible to speculate that dentinal tubules serve as a channel for the dissemination of microorganisms.

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

OBJECTIVES

The objective of this retrospective study was to determine possible prognostic factors of endodontic-periodontal lesions and to compare success, survival, and failure outcomes of treated endodontic-periodontal lesions across different treatment modalities, demographic variables, and anatomical tooth variations.

MATERIALS AND METHODS

Data was collected from patient records in the patient management system (Salud, Titanium Solutions) from the Griffith University Dental Clinic between January 2008 and December 2021. The search strategy used the terms "endodontic periodontal lesion," "periodontal endodontic lesion," "endo perio lesion," "perio endo lesion," and "EPL." The 88 cases which met inclusion and exclusion criteria were analyzed.

RESULTS

The overall success rate was 46.6%, with 21.6% of teeth surviving and 31.8% of teeth failing. Bone loss extending to the apical third (OR = 0.3, 95% CI [0.104, 0.866]), and probing depths of 5-7 mm (OR = 0.147, 95% CI [0.034, 0.633]) and 8-10 mm (OR = 0.126, 95% CI [0.029, 0.542]) were associated with a statistically significant lower odds of success (p < .05). A history of no periodontal disease (OR = 7.705, 95% CI [1.603, 37.037]) was associated with a statistically significant higher odds of success (p < .05).

CONCLUSION

Practitioners should be aware of bone loss to the apical third, deep probing depths, and a history of periodontal disease as possible prognostic factors that can affect the success rate when treating endodontic-periodontal lesions. Further research with more stringent control over operator factors should be done to investigate these variables.

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

This study aims to evaluate the clinical efficacy of periodontal endoscopy (PEND) during subgingival debridement to treat periodontitis. A systematic review of randomized clinical trials (RCTs) was performed. The search strategy included four databases: PubMed, Web of Sciences, Scopus, and Scielo. The initial online exploration generated 228 reports, and 3 RCTs met the selection criteria. These RCTs described a statistically significant decrease in probing depth (PD) in the PEND group compared to controls after 6 and 12 months of follow-up. The improvement in PD was 2.5 mm for PEND and 1.8 mm for the control groups, respectively (p < 0.05). It was also described that the PEND group presented a significantly inferior proportion of PD 7 to 9 mm at 12 months (0.5%) as compared to the control group (1.84%) (p = 0.03). All RCTs noted improvements in clinical attachment level (CAL). It was described as having significant differences in bleeding on probing (BOP) in favor of PEND, with an average reduction of 43% versus 21% in the control groups. Similarly, it was also presented that they were significant differences in plaque indices in favor of PEND. PEND during subgingival debridement to treat periodontitis demonstrated efficacy in reducing PD. Improvement was also observed in CAL and BOP.