Lesions of Endodontic Periodontal Origin

  • Igor Tsesis
  • Carlos E. Nemcovsky
  • Joseph Nissan
  • Eyal Rosen


The advance of the endodontic disease involves inflammatory reaction of the peri-radicular tissues while the periodontal involves marginal periodontium and results in the progressive loss of the supportive tissues. There are multiple routes of communication between the root canal space and marginal periodontium. By these communications the bacteria from the root canal space may contaminate and infect the marginal periodontium and vice versa. While in most cases the manifestation of the periodontal and endodontic diseases is clearly distinct, there are certain clinical scenarios when the signs and symptoms may be confusing, making the final diagnosis complicated and subsequently result in the wrong treatment choice.


Endodontic disease Periodontal disease Bacteria Diagnosis Treatment alternative 


  1. 1.
    Cahn LR. The pathology of pulps found in pyorrhetic teeth. Dent Items Int. 1927;49:598–617.Google Scholar
  2. 2.
    Simring M, Goldberg M. The pulpal pocket approach: retrograde periodontitis. J Periodontol. 1964;35:22–48.CrossRefGoogle Scholar
  3. 3.
    Chen SY, Wang HL, Glickman GN. The influence of endodontic treatment upon periodontal wound healing. J Clin Periodontol. 1997;24(7):449–56.CrossRefGoogle Scholar
  4. 4.
    Weine F. Endodontic therapy. Saint Luis: Mosby; 1972.Google Scholar
  5. 5.
    Signoretti FG, Gomes BP, Montagner F, Jacinto RC. Investigation of cultivable bacteria isolated from longstanding retreatment-resistant lesions of teeth with apical periodontitis. J Endod. 2013;39(10):1240–4.CrossRefGoogle Scholar
  6. 6.
    Jakovljevic A, Knezevic A, Karalic D, Soldatovic I, Popovic B, Milasin J, et al. Pro-inflammatory cytokine levels in human apical periodontitis: correlation with clinical and histological findings. Aust Endod J. 2015;41(2):72–7.CrossRefGoogle Scholar
  7. 7.
    Ferreira MC, Dias-Pereira AC, Branco-de-Almeida LS, Martins CC, Paiva SM. Impact of periodontal disease on quality of life: a systematic review. J Periodontal Res. 2017;52(4):651–65.CrossRefGoogle Scholar
  8. 8.
    Belk CE, Gutmann JL. Perspectives, controversies and directives on pulpal-periodontal relationships. J Can Dent Assoc. 1990;56(11):1013–7.PubMedGoogle Scholar
  9. 9.
    Kerekes K, Olsen I. Similarities in the microfloras of root canals and deep periodontal pockets. Endod Dent Traumatol. 1990;6(1):1–5.CrossRefGoogle Scholar
  10. 10.
    Rocas IN, Siqueira JF Jr, Santos KR, Coelho AM. “Red complex” (bacteroides forsythus, porphyromonas gingivalis, and treponema denticola) in endodontic infections: a molecular approach. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;91(4):468–71.CrossRefGoogle Scholar
  11. 11.
    Simon JH, Glick DH, Frank AL. The relationship of endodontic-periodontic lesions. J Endod. 2013;39(5):e41–6.CrossRefGoogle Scholar
  12. 12.
    Zanini M, Meyer E, Simon S. Pulp inflammation diagnosis from clinical to inflammatory mediators: a systematic review. J Endod. 2017;43(7):1033–51.CrossRefGoogle Scholar
  13. 13.
    Genco RJ, Borgnakke WS. Risk factors for periodontal disease. Periodontol. 2013;62(1):59–94.CrossRefGoogle Scholar
  14. 14.
    Haffajee AD, Socransky SS. Microbiology of periodontal diseases: introduction. Periodontol. 2005;38:9–12.CrossRefGoogle Scholar
  15. 15.
    Loe H. The role of bacteria in periodontal diseases. Bull World Health Organ. 1981;59(6):821–5.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Arambawatta K, Peiris R, Nanayakkara D. Morphology of the cemento-enamel junction in premolar teeth. J Oral Sci. 2009;51(4):623–7.CrossRefGoogle Scholar
  17. 17.
    Bender IB, Seltzer S. The effect of periodontal disease on the pulp. Oral Surg Oral Med Oral Pathol. 1972;33(3):458–74.CrossRefGoogle Scholar
  18. 18.
    Gautam S, Galgali SR, Sheethal HS, Priya NS. Pulpal changes associated with advanced periodontal disease: a histopathological study. J Oral Maxillofac Pathol. 2017;21(1):58–63.CrossRefGoogle Scholar
  19. 19.
    Gutmann JL. Prevalence, location, and patency of accessory canals in the furcation region of permanent molars. J Periodontol. 1978;49(1):21–6.CrossRefGoogle Scholar
  20. 20.
    Komabayashi T, Nonomura G, Watanabe LG, Marshall GWJ, Marshall SJ. Dentin tubule numerical density variations below the CEJ. J Dent. 2008;36(11):953–8.CrossRefGoogle Scholar
  21. 21.
    Ricucci D, Siqueira JF Jr. Fate of the tissue in lateral canals and apical ramifications in response to pathologic conditions and treatment procedures. J Endod. 2010;36(1):1–15.CrossRefGoogle Scholar
  22. 22.
    Simon JH, Glick DH, Frank AL. The relationship of endodontic-periodontic lesions. J Periodontol. 1972;43(4):202–8.CrossRefGoogle Scholar
  23. 23.
    Torabinejad M, Trope M. Endodontic and periodontal interrelationships. In: Walton RE, Torabinejad M, editors. Principles and Practice of Endodontics; 1996.Google Scholar
  24. 24.
    Tsesis I, Rosenberg E, Faivishevsky V, Kfir A, Katz M, Rosen E. Prevalence and associated periodontal status of teeth with root perforation: a retrospective study of 2,002 patients’ medical records. J Endod. 2010;36(5):797–800.CrossRefGoogle Scholar
  25. 25.
    Kurihara H, Kobayashi Y, Francisco IA, Isoshima O, Nagai A, Murayama Y. A microbiological and immunological study of endodontic-periodontic lesions. J Endod. 1995;21(12):617–21.CrossRefGoogle Scholar
  26. 26.
    Ng YL, Mann V, Gulabivala K. Tooth survival following non-surgical root canal treatment: a systematic review of the literature. Int Endod J. 2010;43(3):171–89.CrossRefGoogle Scholar
  27. 27.
    Martin-Cabezas R, Davideau JL, Tenenbaum H, Huck O. Clinical efficacy of probiotics as an adjunctive therapy to non-surgical periodontal treatment of chronic periodontitis: a systematic review and meta-analysis. J Clin Periodontol. 2016;43(6):520–30.CrossRefGoogle Scholar
  28. 28.
    Singh P. Endo-perio dilemma: a brief review. Dent Res J. 2011;8(1):39–47.Google Scholar
  29. 29.
    Terlemez A, Alan R, Gezgin O. Evaluation of the periodontal disease effect on pulp volume. J Endod. 2018;44(1):111–4.CrossRefGoogle Scholar
  30. 30.
    Mileman PA, van den Hout WB. Evidence-based diagnosis and clinical decision making. Dentomaxillofac Radiol. 2009;38(1):1–10.CrossRefGoogle Scholar
  31. 31.
    Rosenberg W, Donald A. Evidence based medicine: an approach to clinical problem-solving. BMJ. 1995;310(6987):1122–6.CrossRefGoogle Scholar
  32. 32.
    Schmidt JC, Walter C, Amato M, Weiger R. Treatment of periodontal-endodontic lesions--a systematic review. J Clin Periodontol. 2014;41(8):779–90.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Igor Tsesis
    • 1
  • Carlos E. Nemcovsky
    • 2
  • Joseph Nissan
    • 3
    • 4
  • Eyal Rosen
    • 1
  1. 1.Department of EndodontologySchool of Dental Medicine, Tel Aviv UniversityTel AvivIsrael
  2. 2.Department of Periodontology and Implant DentistryThe Maurice and Gabriela School of Dental Medicine, Tel Aviv UniversityTel AvivIsrael
  3. 3.Department of Oral Rehabilitation School of Dental-MedicineTel Aviv UniversityTel AvivIsrael
  4. 4.Rabin Medical-CenterBelinson HospitalPetah-TikvaIsrael

Personalised recommendations