A pilot study of treatment of periodontal-endodontic lesions

Objective: A pilot study to evaluate a standardised treatment protocol for combined periodontal-endodontic lesions (involving staged endodontic and periodontal treatment). Participants: Nine patients with a diagnosis of a combined periodontal-endodontic lesion. Methods: At baseline, root canal treatment (RCT) was performed by a standard protocol, and simple scaling/oral hygiene instruction provided. After one month, a standardised episode of non-surgical periodontal treatment was undertaken to address residual pocketing. Clinical measurements, including probing depths, attachment levels and bleeding on probing were recorded at baseline, month one and month three. Long-cone periapical radiographs taken using standardised projection geometry at baseline and month three were analysed for bone changes using digital subtraction radiography (DSR). Results: During the study, one patient's affected tooth was extracted. From baseline to month three, there were statistically significant mean probing depth reductions (Delta= 0.95mm, 95% Cl= 0.20mm, 1.70mm; p= 0.02), mean attachment gains (Delta= 1.13mm, 95% Cl= 0.29mm, 1.96mm; p= 0.02) and reduction in mean bleeding on probing (Delta= 29%, 95% Cl= 10%, 49%; p= 0.01). DSR analysis revealed that between month 0 and month three, four teeth demonstrated bone gain, two teeth exhibited bone loss and two teeth 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 pilot study, treatment of periodontal-endodontic lesions by performing RCT prior to periodontal treatment was effective, resulting in improvements in clinical parameters together with alveolar bone gains in a majority of teeth.