The endodontic lesion: Conclusions
The endodontic lesion always produces some kind of periodontal lesion, be it microscopic or macroscopic, but it can be completely reversed by root canal
The pure periodontal injury, or an independent one established on an initially endodontic lesion, always requires not only endodontic treatment but also periodontal treatment in order to regenerate the lost attachment, consequently ensuring success of the endodontic treatment.
It is very important to have information on the initial pathology to treat an endo-perio lesion.
The pulp test, in a tooth without root canal treatment, is the most reliable for the differential diagnosis of an endo-perio pathology. This is because the site, shape and extension of the radiotransparent bone lesion, as well as the signs and symptoms of pain, inflammation, abscess, or an increase in the probing depth, are not always enough to distinguish a periodontal injury from an endodontic one.
When the clinician cannot make a definitive diagnosis and the pulp test is negative, it may be prudent to proceed with the endodontic treatment and get the tooth free from the occlusion and wait for the reparation to be produced. As the effects produced by these lesions can be completely reversed and regenerated, the clinician should resist the temptation to apply a periodontal treatment, because this kind of intervention will produce injuries in the attachment apparatus, definitively delaying the speed of healing and regeneration of the lesion.
It is necessary to wait for the treatment to regenerate the periodontal lesion; but if after a judicious wait the lesion does not completely disappear, the clinician is facing a true endo-perio lesion. In this case the periodontal treatment will have to be applied also in order to heal the periodontal part of the injury. Remember that with an endo-perio injury the prognosis will depend on the periodontal prognosis.
Once it is understood that the endo-perio lesion is an inflammatory dynamic process of bone destruction, it should be considered as a complex environment during endodontic surgery. The most complex of these defects is well known as the apicomarginal bone defect.