Evaluation of a Standardized Treatment Protocol for Periodontal-Endodontic Lesions

Methods: 8 patients (aged 18 years or older) with a diagnosis of a combined periodontal-endodontic lesion were recruited. At baseline, root canal treatment (RCT) was performed using a standard technique, and any visible calculus deposits were removed. After 1 month, a standardized episode of scaling and root planing of the affected tooth was undertaken under local anaesthesia. Clinical measurements, including probing depths, attachment levels and bleeding on probing were recorded at baseline and month 3. Long-cone periapical radiographs were taken using standardized projection geometry (requiring the use of a custom-made stent) at baseline and month 3, and analysed for bone changes using digital subtraction radiography (DSR). Statistical analyses included paired parametric (t-test) and non-parametric (Wilcoxon signed rank test) analyses of per-patient mean changes, as appropriate.

Results: During the study, one patient’s affected tooth was extracted. From baseline to month 3, there were statistically significant probing depth reductions (mean reduction 0.94 mm ± 0.37 mm), attachment gains (mean gain 1.02 mm ± 0.39 mm) and reduction in bleeding on probing (mean reduction 24% ± 7%) (P<0.05). Radiographic analysis using DSR revealed that 4 teeth demonstrated bone gain, 2 teeth exhibited bone loss and 1 tooth showed no change. The mean bone change was in favour of bone gain but failed to achieve statistical significance (P>0.05).

Conclusions: Within the limitations of this short pilot study, treatment of periodontal–endodontic lesions by performing RCT prior to periodontal treatment appears to be effective, resulting in improvements in clinical parameters together with alveolar bone gains in a majority of teeth.