Endodontic management of the endodontic–periodontal lesion: Understanding proper diagnosis and clinical treatment to achieve periradicular healing

In some situations, periradicular lesions of endodontic origin may be difficult to distinguish from lesions caused by periodontal disease. When a sinus tract originating from an endodontic lesion drains alongside the periodontal ligament, the lesion may give the radiographic and clinical appearance of a periodontal pocket. Cone beam computed tomography (CBCT) may also show extensive destruction of the periradicular tissues but lacks information

regarding remaining areas with soft tissue attachment. Using all diagnostic means to obtain an accurate diagnosis of these lesions is crucial to the delivery of suitable treatment in order to achieve periradicular healing.

The aim of this lecture is to review the mechanisms of bone lesion formation caused by pulpal disease with a potential extension into the oral cavity, as well as the diagnosis involved and clinical treatment of such endodontic–periodontal lesions. This lecture will also discuss healing controversies in 2019, when should we expect healing and when no to.