Endo-periodontal lesions Endo-periodontal lesions should be classified according to signs and symptoms that have direct impact on their prognosis and treatment (such as the presence or absence of fractures and perforations, and the presence or absence of periodontitis). Case definition : An endo-periodontal lesion is a pathological communication between the pulpal and periodontal tissues at a given tooth that may occur in an acute or a chronic form. The primary signs associated with this lesion are deep periodontal pockets extending to the root apex and/or a negative/altered response to pulp-vitality tests. Other signs/symptoms may include: (a) radiographic evidence of bone loss in the apical or furcation region, (b) spontaneous pain or pain on palpation/percussion, (c) purulent exudate/suppuration, (d) tooth mobility, (e) sinus tract/fistula, (f) crown and/or gingival colour alterations. Signs observed in endo-periodontal lesions associated with traumatic and/or iatrogenic factors may include root perforation, fracture/cracking, or external root resorption. These conditions drastically impair the prognosis of the involved tooth.
Classification of endo-periodontal lesions
Root fracture or cracking
Endo-periodontal lesion with root damage
External root resorption Root-canal or pulp-chamber perforation
Grade 1 - narrow deep periodontal pocket in one tooth surface Grade 2 - wide deep periodontal pocket in one tooth surface
Endo-periodontal lesion in periodontitis patients
Grade 3 - deep periodontal pocket in more than one tooth surface
Endo-periodontal lesion without root damage
Grade 1 - narrow deep periodontal pocket in one tooth surface Grade 2 - wide deep periodontal pocket in one tooth surface
Endo-periodontal lesion in non-periodontitis patients
Grade 3 - deep periodontal pocket in more than one tooth surface
Endo-periodontal lesion (Grade 3) in a periodontitis patient (Photo: H. Dommisch)
Systemic and other periodontal conditions
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Guidance for clinicians
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