Perio-endo lesions: Diagnostic dilemmas and clinical approaches formanagement.

ABSTRACT

The pulp and periodontium due to their common embryologic origin, share natural anatomic pathways of communication (apical foramina, lateral canals, exposed dentinal
tubules, or developmental grooves). Additional acquired pathways of communication may emerge in the lifetime of a tooth via pathological or iatrogenic processes, such as cracks and
root fractures, root resorption, cemental tears, or perforations. This intimate relationship and the common borderland of endodontic and periodontal conditions may create similarities in their clinical and radiographic manifestations, whereby each condition has the potential for mimicking the other, or even result in combined endo-perio lesions.
Εndo-perio lesions with or without root damage can pose diagnostic dilemmas as the aetiology of the lesion can be elusive, while the contribution of each disease to the lesion
can often be clinically indistinguishable. The determination of prognosis should rely on correctly identifying the origin of the lesion that may involve post-hoc review, while the
clinical management may involve complex multidisciplinary treatment strategies. Particularly in combined endo-perio lesions with severe periodontal destruction around the affected
teeth, the prognosis depends largely on the extent of destruction caused by the periodontal disease component. Therefore, the periodontal prognosis must first be ascertained, taking
into consideration diagnostic data both at a tooth level and at a patient level.
This case-based presentation will provide an overview of different types of perio-endo lesions and describe the diagnostic thought-process and the utility (and limitations) of
specific diagnostic aids for reaching a diagnosis. The role of CBCT imaging in identifying the pattern and extent of bone loss and revealing root defects will also be highlighted. The
discussion of clinical management will explore the prognosis of perio-endo lesions, highlighting factors that may predispose to a compromised clinical outcome, and describe
the potential efficacy of multidisciplinary treatment strategies.