Management of the Endodontic–Periodontal Lesions (EPL): A Case Series

Abstract: Endodontic-Periodontal Lesions (EPL) often progress slowly without obvious symptoms, unless exacerbated by swelling or pus discharge. The aim of this report is to investigate whether a short waiting time (simultaneous or within a 1-month interval) between non-surgical endodontic and periodontal treatment affects the prognosis, root resection considerations and influencing factors associated with the efficacy of treatment for true-combined EPL. Materials and Methods: This case series selected three examples of true-combined EPL. In cases 1 and 2, a short waiting period between non-surgical endodontic and the subsequent periodontal treatment was implemented, simultaneously in case 1 and after a 1-month interval in case 2. In case 3, we presented a treatment sequence of vertical root fracture related EPL. Probing depth (PD), clinical attachment level (CAL), furcation involvement, mobility and radiograph were recorded and evaluated 6 months after the final treatments. Results: In case 1, the deepest PD changed from 8 mm to 4 mm; CAL changed from 11 mm to 8 mm. In case 2, the deepest PD changed from 10 mm to 3 mm; CAL changed from 10 mm to 5 mm. In case 3, the deepest PD changed from 7mm to 3mm; CAL changed from 10mm to 4mm. As for the radiograph, all cases with obvious bone fill 6 months after the final treatments. Conclusion: When facing the true combined EPL, from these cases we can implement non-surgical endodontic and periodontal treatment simultaneously or within a short waiting period, with a favorable outcome coming after a 6 month follow up. When the vertical root fracture is suspected, inflammation control and a flap operation to ascertain the diagnosis are indicated.