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Decisions in DentistryClassification of Endodontic-Periodontal Lesions

An in-depth examination of primary endodontic lesions alongside primary endodontic lesions that also present secondary periodontal involvement.

Navigating the endodontic-periodontal continuum presents challenges due to their interconnected nature. A nuanced understanding of this relationship is crucial for accurate diagnosis and successful treatment.

Key Points:

  • Determining the precise etiology of an endodontic-periodontal lesion is challenging due to their similar signs and symptoms.
  • The root canal system and periodontium communicate primarily through apical foramina, with smaller canals and dentinal tubules serving as additional pathways.
  • Both endodontic and periodontal pathologies can cause one another, though there is conflicting evidence about the influence of periodontal disease on pulpal disease.
  • Simon et al classified endodontic-periodontal lesions into five categories: primary endodontic, primary endodontic with secondary periodontal, primary periodontal, primary periodontal with secondary endodontic, and true combined lesions.
  • True combined lesions are rare and require both root canal treatment and periodontal therapy.

Additional Points:

  • Vertical root fractures, developmental malformations, internal and external resorption, perforations, and horizontal root fractures also act as communication avenues between the root canal system and periodontium.
  • Factors such as smoking history, extensive clinical attachment loss, deep probing depths, and severity of full-mouth periodontitis can affect the prognosis of some endodontic-periodontal lesions.
  • Accurate diagnosis of endodontic-periodontal lesions is essential for appropriate therapy initiation.


  • Correctly diagnosing endodontic-periodontal lesions is a critical step in initiating appropriate treatment, which can vary from root canal treatment, periodontal treatment, or a combination of both, depending on the specific type of lesion.

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Did You Know?
According to a study published in the Journal of Endodontics, more than 15 million root canal treatments are performed annually in the United States.

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