Special Issue "Etiology, Classification and Management of Endodontic-Periodontal Lesions"

A special issue of Applied Sciences (ISSN 2076-3417). This special issue belongs to the section "Applied Dentistry and Oral Sciences".

Deadline for manuscript submissions: closed (20 July 2023) | Viewed by 19612

Special Issue Editor

Prof. Dr. Igor Tsesis
E-Mail Website
Guest Editor
Department of Endodontology, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv 61000, Israel
Interests: evidence based endodontics
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

While dental pulp and the periodontium are two distinct tissues, there are many potential routes of interaction between them, such as the apical foramen, dentinal tubules, lateral and accessory canals, anatomical variations, pathological conditions and treatment complications such as root fractures or perforations. Following bacterial colonization, the exposure of endodontic biofilm to the periodontium and vice versa may initiate pathological processes in these tissues.

This Special Issue will present the current research on the etiological factors of endodontic–periodontal lesions, classifications, prognoses and modern approaches to the clinical management of these pathologies using endodontic, periodontal, and restorative procedures, as well as treatment alternatives in cases when extraction is necessary.

Prof. Dr. Igor Tsesis
Guest Editor

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Keywords

  • endodontic–periodontal lesions
  • infection
  • bacterial biofilm
  • perforations
  • root fractures
  • resorption
  • diagnosis
  • evidence-based decision-making
  • periodontal disease
  • surgical endodontic treatment
  • dental implants
  • guided tissue regeneration

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Published Papers (8 papers)

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Research

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Article
Maximal Bite Force Measured via Digital Bite Force Transducer in Subjects with or without Dental Implants—A Pilot Study
Appl. Sci. 2022, 12(3), 1544; https://doi.org/10.3390/app12031544 - 31 Jan 2022
Cited by 11 | Viewed by 3250
Abstract
The aims of the current study were as following: (1) to evaluate the maximal bite forces in patients with dental implants versus patients without dental implants, as measured by a digital bite force transducer (GM10); (2) to evaluate the influences of sex, age, [...] Read more.
The aims of the current study were as following: (1) to evaluate the maximal bite forces in patients with dental implants versus patients without dental implants, as measured by a digital bite force transducer (GM10); (2) to evaluate the influences of sex, age, and sleep/awake bruxism on the maximal bite forces of the two groups. Forty patients recruited to the study were divided into two groups: test group (“implant”) if they had one or more posterior restored implants and control group (“no-implant”) without the presence of posterior dental implants. A digital bite fork (GM10) was used to measure the bite forces from three posterior occluding pairs in all participants. Differences in the mean values between the test and control groups and between different sexes were evaluated using one-way and two-way ANOVA tests. A cross-tabulation analysis was conducted to identify a trend line between the groups. There was no significant difference in the maximal bite force between the test and control groups (p = 0.422), but the cross-tabulation analysis revealed a clear trend of a stronger representation of the “no-implant” group at higher occlusal forces. A significant difference was detected between the maximal biting forces of male and female subjects (p = 0.030 in the implant group, p = 0.010 in the no-implant group), regardless of the experimental group. The presence of bruxism and clenching did not influence the bite force values (p = 0.953), and a significant difference was not found between the age groups (p = 0.393). Within the limitations of this study, it may be assumed that there was no significant difference between the maximal bite forces between patients with and without dental implants but that there was a trend line implicating a stronger representation of the “no-implant” group at higher forces. In addition, the results revealed a significant sex-related difference in the maximal occlusal force. Further studies with larger sample sizes are warranted. Full article
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Article
Histological Evaluation of Multisonic Technology for Debridement of Vital and Necrotic Pulp Tissues from Human Molar Teeth. An Observational Study
Appl. Sci. 2021, 11(22), 11002; https://doi.org/10.3390/app112211002 - 20 Nov 2021
Viewed by 2271
Abstract
Background: This study evaluated the efficacy of a multisonic technology for the debridement of vital and necrotic pulp tissues in freshly extracted human mandibular molar teeth. Methods: Twelve teeth with a diagnosis of symptomatic irreversible pulpitis (SIP) and twelve teeth with a diagnosis [...] Read more.
Background: This study evaluated the efficacy of a multisonic technology for the debridement of vital and necrotic pulp tissues in freshly extracted human mandibular molar teeth. Methods: Twelve teeth with a diagnosis of symptomatic irreversible pulpitis (SIP) and twelve teeth with a diagnosis of pulp necrosis with symptomatic apical periodontitis (SAP) were extracted. The GentleWave® procedure was performed on 10 teeth from each group. Four non-treated teeth served as histologic controls. Histological consecutive 5 µm sections were obtained from the apical, middle, and coronal portion of the canals. The canals were evaluated for the presence of pulpal debris and bacteria. Results: In nine out of the ten specimens with SIP, no pulpal debris was detected in any portion of the canals. In the necrotic pulp group, eight out of the ten specimens had no detectable pulpal debris in any portion of the canal spaces. No bacteria were detected in the main canals, isthmuses, or lateral canals, but were detected deep within the dentinal tubules in 10 specimens. Conclusions: This study demonstrated that the multisonic technology was effective at removing vital and necrotic pulp tissue as well as bacteria from the root canal system, including inaccessible areas. Full article
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Article
Influence of the Periapical Status of the Posterior Maxillary Teeth on the Width of the Schneiderian Membrane of the Maxillary Sinus Mucosa
Appl. Sci. 2021, 11(9), 3908; https://doi.org/10.3390/app11093908 - 26 Apr 2021
Cited by 3 | Viewed by 2152
Abstract
Background: Various parameters are known to affect the amount and type of mucosal thickening. The aim of this retrospective study was to investigate these effects through a survey of cone-beam computed tomography (CBCT) images. CBCT scans of 150 patients, which included the area [...] Read more.
Background: Various parameters are known to affect the amount and type of mucosal thickening. The aim of this retrospective study was to investigate these effects through a survey of cone-beam computed tomography (CBCT) images. CBCT scans of 150 patients, which included the area of the MS and maxillary teeth (canine, first premolar, second premolar, first molar, second molar, and third molar), were evaluated retrospectively for the presence of sinus mucosal thickening. The parameters evaluated as possible causes of mucosal thickening were age, sex, tooth type, proximity to the maxillary sinus, endodontic treatment, and periapical lesion. Descriptive statistics and multiple logistic regression were used to analyze the data. A total of 28% of the teeth presented with mucosal thickening, which was associated with periapical lesions in 57.1% of 77 cases. The size of the lesion was the only parameter that was found to be significantly connected to the presence of mucosal thickness. More than 50% of teeth with periapical lesions in the posterior maxilla exhibited mucosal thickening. Other parameters such as age, sex, and the position of the root tips in relation to the MS floor did not influence the probability of developing mucosal thickening. Full article
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Article
Bacterial Colonization and Proliferation in Furcal Perforations Repaired by Different Materials: A Confocal Laser Scanning Microscopy Study
Appl. Sci. 2021, 11(8), 3403; https://doi.org/10.3390/app11083403 - 10 Apr 2021
Cited by 1 | Viewed by 1392
Abstract
Following furcal perforation, bacteria may colonize the defect and cause inflammation and periodontal destruction. This study used confocal laser scanning microscopy (CLSM) to evaluate Enterococcus faecalis colonization and proliferation in furcal perforations repaired with different materials. Furcal perforations created in 55 extracted human [...] Read more.
Following furcal perforation, bacteria may colonize the defect and cause inflammation and periodontal destruction. This study used confocal laser scanning microscopy (CLSM) to evaluate Enterococcus faecalis colonization and proliferation in furcal perforations repaired with different materials. Furcal perforations created in 55 extracted human mandibular molars were repaired using either MTA-Angelus, Endocem, or Biodentine and coronally subjected to E. faecalis suspension for 21 days. The specimens were then stained using a LIVE/DEAD Viability Kit and visualized by CLSM. The minimum and maximum depths of bacterial penetration into the dentinal tubules were 159 and 1790 μM, respectively, with a mean of 713 μM. There were significantly more live than dead bacteria inside the dentinal tubules (p = 0.0023) in all groups, and all three repair materials exhibited a similarly sized stained area (p = 0.083). However, there were significant differences in the numbers of dead bacteria at the circumference of the perforation defect (p = 0.0041), with a significantly higher ratio of live to dead bacteria in the MTA-Angelus group (p = 0.001). Following perforation repair, bacteria may colonize the interface between the repair material and dentin and may penetrate through the dentinal tubules. The type of repair material has a significant effect on the viability of the colonizing bacteria. Full article
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Systematic Review
Diagnosis Efficacy of Cone-Beam Computed Tomography in Endodontics—A Systematic Review of High-Level-Evidence Studies
Appl. Sci. 2022, 12(3), 938; https://doi.org/10.3390/app12030938 - 18 Jan 2022
Cited by 2 | Viewed by 2029
Abstract
Introduction: The integration of clinical inspection and diagnostic imaging forms the basis for endodontic diagnosis, decision making, treatment planning, and outcome assessments. In recent years, CBCT imaging has become a common diagnostic tool in endodontics. CBCT should only be used to ensure that [...] Read more.
Introduction: The integration of clinical inspection and diagnostic imaging forms the basis for endodontic diagnosis, decision making, treatment planning, and outcome assessments. In recent years, CBCT imaging has become a common diagnostic tool in endodontics. CBCT should only be used to ensure that the benefits to the patient exceed the risks. As such, our aim in this study was to evaluate the high level diagnostic efficacy studies and their risk of bias. Methods: A systematic search of the literature was conducted to identify studies evaluating the use of CBCT imaging in endodontics. The following databases were searched: Medline (PubMed), Scopus, and Cochrane Central. The identified studies were subjected to rigorous inclusion criteria. Studies considered as having a high efficacy level were then subjected to a risk of bias assessment using the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. Results: Initially, 1568 articles were identified for possible inclusion in the review. Following title and abstract assessment, duplicate removal, and a full-text evaluation, 22 studies were included. Of those studies, 2 had a low risk of bias and 20 had a high risk of bias. Six studies investigated non-surgical treatment, eight investigated surgical treatment, two investigated both non-surgical and surgical treatment, and six studies investigated diagnostic thinking or decision making. Conclusion: The evidence for the influence of CBCT on decision making and treatment outcomes in endodontics is predominantly based on studies with a high risk of bias. Full article
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Case Report
Endodontic Management of Endo-Perio Lesions
Appl. Sci. 2021, 11(23), 11293; https://doi.org/10.3390/app112311293 - 29 Nov 2021
Cited by 1 | Viewed by 2198
Abstract
An endo-perio lesion is one of the more common tooth-related problems. An association between the presence of apical and marginal periodontitis is known in the literature and has been observed in 5.7% of individuals aged 40–45 years old. The purpose of the present [...] Read more.
An endo-perio lesion is one of the more common tooth-related problems. An association between the presence of apical and marginal periodontitis is known in the literature and has been observed in 5.7% of individuals aged 40–45 years old. The purpose of the present article is to present three case reports describing the successful retreatment of endo-perio lesions. In each of these cases, we used a biologically active bioceramic root canal sealer, GuttaFlow Bioseal, which is a bioactive root canal filling material composed of gutta percha, polydimethylsiloxane, platinum catalyzer, zirconium dioxide, and bioglass. All cases were followed up clinically and radiographically for a period of at least 11 months. Full article
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Systematic Review
Pathognomonic Combination of Clinical Signs for Diagnosis of Vertical Root Fracture: Systematic Review of the Literature
Appl. Sci. 2021, 11(22), 10893; https://doi.org/10.3390/app112210893 - 18 Nov 2021
Cited by 1 | Viewed by 1432
Abstract
Introduction: Vertical root fracture (VRF) is a root-canal treatment complication and is a major reason for extraction of the root-canal-treated teeth. The diagnosis of VRF can be complicated because of absence of specific signs, symptoms, and radiographic features. A combination that includes the [...] Read more.
Introduction: Vertical root fracture (VRF) is a root-canal treatment complication and is a major reason for extraction of the root-canal-treated teeth. The diagnosis of VRF can be complicated because of absence of specific signs, symptoms, and radiographic features. A combination that includes the presence of deep pocket and a sinus tract in root-canal-treated tooth was proposed as a pathognomonic for VRF. The purpose of this study was to systematically search and evaluate the literature regarding the correlation between the clinical signs considered pathognomonic for the diagnosis of VRF, with the actual reference standard by means of systematic review of the literature. Methods: A systematic search of the literature was performed to identify studies evaluating the clinical signs considered pathognomonic for the diagnosis of VRF. The following databases were searched: Medline (PubMed), Scopus, and Cochrane Central. The identified studies were subjected to strict inclusion and exclusion criteria. Results: Initially, 1141 possible relevant articles were identified. After title and abstract screening, 40 articles were subjected to a full-text evaluation, 3 articles met the inclusion criteria and contained data regarding the prevalence of the pathognomonic combination in VRF’s-confirmed teeth. The presence of deep pocket and a sinus tract in endodontically treated teeth was found in 28% of the cases. Conclusion: To date, the current scientific knowledge regarding the correlation between the clinical symptoms considered pathognomonic for VRF diagnosis in the root-canal-treated tooth and the actual reference standard is quite low. Full article
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Systematic Review
Platelet-Rich Fibrin: A Viable Therapy for Endodontic-Periodontal Lesions? A Preliminary Assessment
Appl. Sci. 2021, 11(15), 7081; https://doi.org/10.3390/app11157081 - 31 Jul 2021
Cited by 2 | Viewed by 3903
Abstract
Background and Objectives: The endodontic system and the periodontium are closely interrelated and the infection of both leads to the appearance of endodontic-periodontal lesions. Along with the endodontic and periodontal classic treatment, in most cases, there is a need for regenerative periodontal therapy [...] Read more.
Background and Objectives: The endodontic system and the periodontium are closely interrelated and the infection of both leads to the appearance of endodontic-periodontal lesions. Along with the endodontic and periodontal classic treatment, in most cases, there is a need for regenerative periodontal therapy for the repair of the damaged tissue. One material that stimulates bone healing is represented by platelet-rich fibrin (PRF). The aim of this study was to determine if the inclusion of PRF in the treatment protocol of endodontic-periodontal lesions is effective. Materials and Methods: This review was conducted according to the PRISMA guidelines. Four databases, MEDLINE (through PubMed), Scopus, Web of Science, and Google Scholar, were used in order to find all significant articles on the topic. Relevant keywords were used in different combinations. Results: The inclusion criteria were met by six studies, published between 2014 and 2020 and they were selected for the review. The use of PRF for the regenerative therapy of endodontic-periodontal lesions showed favorable outcomes in all of the studies included, with significant reductions in the probing depths. Conclusion: While platelet-rich fibrin may be beneficial, further research is needed. Full article
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