Endo-Periodontal Lesions and the Role of Periodontal Therapy in the Longevity of Endodontically Treated Teeth: A Literature Review
Panagiotis Elafros, Marios Takas, Ioanna Gkolia, Vasiliki-Maria Drizi, Eirini Salvanou, Leonidas Batas, Chariklia Neophytou.
Background: Endo-periodontal lesions represent a complex clinical condition involving pathological communication between the dental pulp and periodontal tissues. Their management remains a diagnostic and therapeutic challenge due to the overlapping etiology and close anatomical interconnection of the pulp and periodontium.
Aim: This review aims to evaluate the influence of periodontal health on the prognosis and long-term survival of endodontically treated teeth (ETT), assess the role of regenerative periodontal techniques in the management of endo-periodontal lesions, and explore the differential diagnosis from other pathological conditions as well as the underlying microbiological etiology.
Methods: A narrative literature review was conducted using electronic databases including PubMed, Scopus, and Cochrane Library, focusing on studies published between 2000 and 2025 in the English language and relevant to this theme. Search terms included “endodontically treated teeth,” “periodontal therapy,” “endo-periodontal lesions,” “apical periodontitis,” “regenerative techniques,” “periodontal diagnosis,” and “microbial etiology.”
Results: The literature indicates that poor periodontal status significantly increases the risk of failure in ETT, with deeper periodontal pockets correlating with lower survival rates. Regenerative periodontal approaches, including the use of enamel matrix derivatives, bone grafts, and guided tissue regeneration, have shown promising outcomes in managing advanced endo-periodontal lesions. Success rates of up to 92% have been reported in long-term follow-ups when these techniques are combined with proper endodontic therapy.
Conclusion: Periodontal health plays a pivotal role in the prognosis of endodontically treated teeth. Accurate diagnosis, strategic sequencing of endodontic and periodontal treatment, and the use of regenerative techniques are essential for successful management of endo-periodontal lesions. A multidisciplinary approach enhances treatment outcomes and supports the long-term preservation of natural dentition.
