Endodontic-Periodontal Lesions: Periodontal Aspects

  • Carlos E. NemcovskyEmail author
  • José Luis Calvo Guirado
  • Ofer Moses


Periodontal-endodontic lesions are the combination of pulp involvement and periodontal disease in the same tooth. Diagnosis may become difficult; however, a differential etiological consideration is indispensable for appropriate treatment.

Cases with endodontic-periodontal lesions usually present with several clinical and radiological features, such as altered response to testing of pulp sensitivity, clinical signs of gingival inflammation, increased probing pocket depth, sinus tracts, pus secretion and different types of radiological bony defects, several areas of the dentition show periodontal involvement, all of which difficult the diagnosis of the primary cause. According to their main initial etiology, periodontal-endodontic lesions may be classified as:
  1. 1.

    Purely periodontal lesion—when a deep periodontal lesion involves most of the root surface, and the dental pulp is vital.

  2. 2.

    Purely endodontic lesion—when the pulp is necrotic and infected, and there is a draining sinus tract coronally through the periodontal ligament into the gingival sulcus.

  3. 3.

    Endodontic-periodontal lesion—when the pulp is necrotic and infected, and there is a deep periodontal pocket.


An accurate prognosis is most critical when periodontal and endodontic therapy are combined with large oral prosthetic rehabilitation or with dental implants; in these complex cases, an accurate long-term prognosis of the involved teeth must be established at the time of treatment planning. Oral implants do not surpass the long-term longevity of teeth, even if periodontal or endodontic problems are present.


Tooth prognosis Periodontal lesions Periodontitis Pathogenesis Periodontal treatment Endodontic 


  1. 1.
    Singh P. EndoPerio dilemma: a brief review. Dent Res J. 2011;8(1):39–47.Google Scholar
  2. 2.
    Al-Fouzan KS. A new classification of endodontic-periodontal lesions. Int J Dent. 2014;2014:919173.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Czarnecki RT, Schilder H. A histological evaluation of the human pulp in teeth with varying degrees of periodontal disease. J Endod. 1979;5:242–53.PubMedCrossRefGoogle Scholar
  4. 4.
    Kombayashi T, Nonomura G, Watanabe LG, Marshall GW Jr, Marshall SJ. Dentin tubule numerical density variations below the CEJ. J Dent. 2008;36:953–8.CrossRefGoogle Scholar
  5. 5.
    Mjor IA, Nordahl I. The density and branching of dentinal tubules in human teeth. Arch Oral Biol. 1996;41:401–12.PubMedCrossRefGoogle Scholar
  6. 6.
    Rotstein I. Interaction between endodontics and periodontics. Periodontol. 2017;74:11–39.CrossRefGoogle Scholar
  7. 7.
    Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol. 1999;4(1):1–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Simon JHS, Glick DH, Frank AL. The relationship of endodontic-periodontic lesions. J Periodontol. 1972;43:202–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Herrera D, Retamal-Valdes B, Alonso B, Feres M. Acute periodontal lesions (periodontal abscesses and necrotizing periodontal diseases) and endo-periodontal lesions. J Clin Periodontol. 2018;45(Suppl 20):S78–94. Scholar
  10. 10.
    Adriaens PA, De Boever JA, Loesche WJ. Bacterial invasion in root cementum and radicular dentin of periodontally diseased teeth in humans: a reservoir of periodontopathic bacteria. J Periodontol. 1988;59:222–30.PubMedCrossRefGoogle Scholar
  11. 11.
    Adriaens PA, Edwards CA, De Boever JA, Loesche WJ. Ultrastructural observations on bacterial invasion in cementum and radicular dentin of periodontally diseased human teeth. J Periodontol. 1988;59:493–503.PubMedCrossRefGoogle Scholar
  12. 12.
    Bender IB, Seltzer S. The effect of periodontal disease on the pulp. Oral Surg Oral Med Oral Pathol. 1972;33:458–74.CrossRefPubMedGoogle Scholar
  13. 13.
    Gold SI, Moskow BS. Periodontal repair of periapical lesions: the borderland between pulpal and periodontal disease. J Clin Periodontol. 1987;14:251–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Mazur B, Massler M. Influence of periodontal disease on the dental pulp. Oral Surg Oral Med Oral Pathol. 1964;17:592–603.PubMedCrossRefGoogle Scholar
  15. 15.
    Seltzer S, Bender IB, Ziontz M. The interrelationship of pulp and periodontal disease. Oral Surg Oral Med Oral Pathol. 1963;16:1474–90.PubMedCrossRefGoogle Scholar
  16. 16.
    Torabinejad M, Johnson JD. Procedural accidents. In: Torabinejad M, Walton RE, Fouad AF, editors. Endodontics: principles and practice. St. Louis: Elsevier; 2015. p. 338–54.Google Scholar
  17. 17.
    Wilson MI, Hall J. Incidence of yeasts in root canals. J Br Endod Soc. 1968;2:56–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Bauchwitz M. Veränderungen der Zahnpulpa und des Paradentium bei Paradentose. Zahnarztl Rundsch. 1932;11:430–438, 1228–1233, 1271–1275.Google Scholar
  19. 19.
    Rubach WC, Mitchell DF. Periodontal disease, accessory canals and pulp pathosis. J Periodontol. 1965;36:34–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Langeland K, Rodrigues H, Dowden W. Periodontal disease, bacteria, and pulpal histopathology. Oral Surg Oral Med Oral Pathol. 1974;37:257–70.PubMedCrossRefGoogle Scholar
  21. 21.
    Bergenholtz G, Lindhe J. Effect of experimentally induced marginal periodontitis and periodontal scaling on the dental pulp. J Clin Periodontol. 1978;5:59–73.PubMedCrossRefGoogle Scholar
  22. 22.
    Schmidt JC, Walter C, Amato M, Weiger R. Treatment of periodontal-endodontic lesions – a systematic review. J Clin Periodontol. 2014;41:779–90.PubMedCrossRefGoogle Scholar
  23. 23.
    Hattler AB, Listgarten MA. Pulpal response to root planing in a rat model. J Endod. 1984;10:471–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Nilveus R, Selvig KA. Pulpal reactions to the application of citric acid to root-planed denti in beagles. J Periodontal Res. 1983;18:420–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Bergenholtz G, Ricucci D, Siqueira JF Jr. Lesions of Endodontic Origin Chapter 25. In: Lang NP, Lindhe J, editors. Clinical periodontology and implant dentistry. 6th ed. Hoboken: John Wiley & Sons, Ltd; 2015. p. 472–501.Google Scholar
  26. 26.
    Chen SY, Wang HL, Glickman GN. The influence of endodontic treatment upon periodontal wound heating. J Clin Periodontol. 1997;24:449–56.CrossRefPubMedGoogle Scholar
  27. 27.
    Lantelme RL, Handelman ST, Herbison RJ. Dentin formation in periodontally diseased teeth. J Dent Res. 1976;55:48–51.PubMedCrossRefGoogle Scholar
  28. 28.
    Dongari A, Lambrianidis T. Periodontally derived pulpal lesions. Endod Dent Traumatol. 1988;4:49–54.PubMedCrossRefGoogle Scholar
  29. 29.
    Kerekes K, Olsen I. Similarities in the microfloras of root canals and deep periodontal pockets. Endod Dent Traumatol. 1990;6:1–5.CrossRefPubMedGoogle Scholar
  30. 30.
    Kipioti A, Nakou M, Legakis N, Mitsis F. Microbiological findings of infected root canals and adjacent periodontal pockets in teeth with advanced periodontitis. Oral Surg Oral Med Oral Pathol. 1984;58:213–20.PubMedCrossRefGoogle Scholar
  31. 31.
    Raheja J, Tewari S, Tewari S, Duhan J. Evaluation of efficacy of chlorhexidine intracanal medicament on the periodontal healing of concomitant endodontic-periodontal lesions without communication: an interventional study. J Periodontol. 2014;85:1019–26.PubMedCrossRefGoogle Scholar
  32. 32.
    Seltzer S, Bender IB, Nazimov H, Sinai I. Pulpitis-induced interradicular periodontal changes in experimental animals. J Periodontol. 1967;38:124–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Heasman PA. An endodontic conundrum: the association between pulpal infection and periodontal disease. Br Dent J. 2014;214:275–9.CrossRefGoogle Scholar
  34. 34.
    Kobayashi T, Hayashi A, Yoshikawa R, Okuda A, Hara K. The microbial flora from root canals and periodontal pockets of non-vital teeth with advanced periodontitis. Int Endod J. 1990;23:100–6.PubMedCrossRefGoogle Scholar
  35. 35.
    Kurihara H, Kobayashi Y, Francisco LA, Isoshima O, Nagai A, Murayama Y. A microbiological and immunological study of endodontic-periodontal lesions. J Endod. 1995;21:617–21.CrossRefPubMedGoogle Scholar
  36. 36.
    Sundqvist G. Associations between microbial species in dental root canal infections. Oral Microbiol Immunol. 1992;7:257–62.PubMedCrossRefGoogle Scholar
  37. 37.
    Zehnder M, Gold SI, Hasselgren G. Pathologic interactions in pulpal and periodontal tissues. J Clin Periodontol. 2002;29:663–71.PubMedCrossRefGoogle Scholar
  38. 38.
    Fish EW, MacLean L. The distribution of oral streptococci in the tissues. Br Dent J. 1936;61:336–62.Google Scholar
  39. 39.
    Sauerwein E. Histopathology of the pulp in instances of periodontal disease. Dent Abstr. 1956;1:467–8.Google Scholar
  40. 40.
    Kirkham DB. The location and incidence of accessory pulpal canals in periodontal pockets. J Am Dent Assoc. 1975;91:353–6.PubMedCrossRefGoogle Scholar
  41. 41.
    Petersson K, Söderström C, Kiani-Anaraki M, Le’vy G. Evaluation of the ability of thermal and electrical tests to register pulp vitality. Endod Dent Traumatol. 1999;15:127–31.PubMedCrossRefGoogle Scholar
  42. 42.
    Jansson L, Ehnevid H, Blomlöf L, Weintraub A, Lindskog S. Endodontic pathogens in periodontal disease augmentation. J Clin Periodontol. 1995;22:598–602.PubMedCrossRefGoogle Scholar
  43. 43.
    Jansson L, Ehnevid H, Lindskog S, Blomlöf L. Relationship between periapical and periodontal status: a clinical retrospective study. J Clin Periodontol. 1993;20:117–23.PubMedCrossRefGoogle Scholar
  44. 44.
    Jansson L, Ehnevid H, Lindskog S, Blomlöf L. Development of periapical lesions. Swed Dent J. 1993;17:85–93.PubMedGoogle Scholar
  45. 45.
    Jansson L, Ehnevid H, Lindskog S, Blomlöf L. Proximal restorations and periodontal status. J Clin Periodontol. 1994;21:577–82.PubMedCrossRefGoogle Scholar
  46. 46.
    Jansson L, Ehnevid H, Lindskog S, Blomlöf L. The influence of endodontic infection on progression of marginal bone loss in periodontitis. J Clin Periodontol. 1995;22:729–34.PubMedCrossRefGoogle Scholar
  47. 47.
    Ehnevid H, Jansson L, Lindskog S, Blomlöf L. Periodontal healing in teeth with periapical lesions: a clinical retrospective study. J Clin Periodontol. 1993;20:254–8.PubMedCrossRefGoogle Scholar
  48. 48.
    Ehnevid H, Jansson LE, Lindskog SF, Blomlöf LB. Periodontal healing in relation to radiographic attachment and endodontic infection. J Periodontol. 1993;64:1199–204.PubMedCrossRefGoogle Scholar
  49. 49.
    Jansson L, Ehnevid H. The influence of endodontic infection on periodontal status in mandibular molars. J Periodontol. 1998;69:1392–6.CrossRefPubMedGoogle Scholar
  50. 50.
    Hammarström LE, Blomlöf LB, Feiglin B, Lindskog SF. Effect of calcium hydroxide treatment on periodontal repair and root resorption. Endod Dent Traumatol. 1986;2:184–9.CrossRefGoogle Scholar
  51. 51.
    Blomlöf L, Lindskog S, Hammarström L. Influence of pulpal treatments on cell and tissue reactions in the marginal periodontium. J Periodontol. 1988;59:577–83.PubMedCrossRefGoogle Scholar
  52. 52.
    Lima LA, Anderson GB, Wang MM, et al. Healing of intrabony defects and its relation to root canal therapy: a histologic and histometric study in dogs. J Periodontol. 1997;68:240–8.PubMedCrossRefGoogle Scholar
  53. 53.
    Bergenholtz G, Lindhe J. Effect of soluble plaque factors on inflammatory reactions in the dental pulp. Scand J Dent Res. 1975;83:153–8.PubMedGoogle Scholar
  54. 54.
    Adyani-Fard D, Kim T-S, Eickholz P. Interproximal bone loss at contralateral teeth with and without root canal filling in periodontitis patients. J Clin Periodontol. 2011;38:269–75.PubMedCrossRefGoogle Scholar
  55. 55.
    Timmerman MF, van der Weijden GA. Bone level around endodontically treated teeth in periodontitis patients. J Clin Periodontol. 2006;33:620–5.PubMedCrossRefGoogle Scholar
  56. 56.
    Craveiro MA, Fontana CE, Sigrist de Martin A, da Silveira Bueno CE. Influence of coronal restoration and root canal filling quality on periapical status: clinical and radiographic evaluation. J Endod. 2015;41:836–40.PubMedCrossRefGoogle Scholar
  57. 57.
    Lulic M, Brägger U, Lang NP, Zwahlen M, Salvi GE. Ante’s (1926) law revisited: a systematic review on survival rates and complications of fixed dental prostheses (FDPs) on severely reduced periodontal tissue support. Clin Oral Implants Res. 2007;18(Suppl. 3):63–72.PubMedCrossRefGoogle Scholar
  58. 58.
    Pretzl B, Eickholz P, Saure D, Pfefferle T, Zeidler A, Dannewitz B. Endodontic status and retention of molars in periodontally treated patients: results after 10 or more years of supportive periodontal therapy. J Clin Periodontol. 2016;43:1116–23.PubMedCrossRefGoogle Scholar
  59. 59.
    Rotstein I, Simon JH. Diagnosis, prognosis and decision making in the treatment of combined periodontal-endodontic lesions. Periodontology 2000. 2004;34:165–203.PubMedCrossRefGoogle Scholar
  60. 60.
    Aksel H, Serper A. A case series associated with different kinds of endoperio lesions. J Clin Exp Dent. 2014;6(1):e91–5.PubMedCrossRefPubMedCentralGoogle Scholar
  61. 61.
    de Miranda JL, Santana CM, Santana RB. Influence of endodontic treatment in the post-surgical healing of human Class II furcation defects. J Periodontol. 2013;84:51–7.PubMedCrossRefGoogle Scholar
  62. 62.
    Ehnevid H, Lindskog S, Blomlöf L. Relationship between periapical and periodontal status: a clinical retrospective study. J Clin Periodontol. 1993;20:117–23.PubMedCrossRefGoogle Scholar
  63. 63.
    Jansson LE, Ehnevid H, Lindskog SF, Blomlöf LB. Radiographic attachment in periodontitis-prone teeth with endodontic infection. J Periodontol. 1993;64:947–53.PubMedCrossRefGoogle Scholar
  64. 64.
    Paul BF, Hutter JW. The endodontic-periodontal continuum revisited: new insights into etiology, diagnosis and treatment. J Am Dent Assoc. 1997;128:1541–8.PubMedCrossRefGoogle Scholar
  65. 65.
    Perlmutter S, Tagger M, Tagger E, Abram M. Effect of the endodontic status of the tooth on experimental periodontal reattachment in baboons: a preliminary investigation. Oral Surg Oral Med Oral Pathol. 1987;63:232–6.PubMedCrossRefGoogle Scholar
  66. 66.
    Solomon C, Chalfin H, Kellert M, Weseley P. The endodontic periodontal lesion: a rational approach to treatment. J Am Dent Assoc. 1995;126:473–9.PubMedCrossRefGoogle Scholar
  67. 67.
    Abbott PV, Salgado JC. Strategies for the endodontic management of concurrent endodontic and periodontal diseases. Aust Dent J. 2009;54:70–85.CrossRefGoogle Scholar
  68. 68.
    Lindhe J. Clinical periodontology and implant dentistry. Munksgaard. 1997;296:318–51.Google Scholar
  69. 69.
    Mandi FA. Histological study of the pulp changes caused by periodontal disease. J Br Endod Soc. 1972;6:80–2.CrossRefGoogle Scholar
  70. 70.
    Rotstein I, Simon JHS. The endo-perio lesion: a critical appraisal of the disease condition. Endod Topics. 2006;13:34–56.CrossRefGoogle Scholar
  71. 71.
    Simring M, Goldberg M. The pulpal pocket approach: retrograde periodontitis. J Periodontol. 1964;35:22–48.CrossRefGoogle Scholar
  72. 72.
    Vakalis SV, Whitworth JM, Ellwood RP, Preshaw PM. A pilot study of treatment of periodontal-endodontic lesions. Int Dent J. 2005;55:313–8.CrossRefPubMedGoogle Scholar
  73. 73.
    Chapple IL, Lumley PJ. The periodontal endodontic interface. Dent Updat. 1999;26:331–6.. 338, 340–1CrossRefGoogle Scholar
  74. 74.
    Haapasalo M, Orstavik D. In vitro infection and disinfection of dentinal tubules. J Dent Res. 1987;66:1375–9.PubMedCrossRefGoogle Scholar
  75. 75.
    Gomes BP, Montagner F, Berber VB, et al. Antimicrobial action of intracanal medicaments on the external root surface. J Dent. 2009;37:76–81.PubMedCrossRefGoogle Scholar
  76. 76.
    Borghetti A, Mattout P, Mattout C. How much root planning is necessary to remove the cementum from the root surface. Int J Periodontics Restorative Dent. 1987;7:23–9.PubMedGoogle Scholar
  77. 77.
    Smart GJ, Wilson M, Davies EH, Kieser JB. The assessment of ultrasonic root surface debridement by determination of residual endotoxin levels. J Clin Periodontol. 1990;17:174–8.PubMedCrossRefGoogle Scholar
  78. 78.
    Stassen IG, Hommez GM, De Bruyn H, De Moor RJ. The relation between apical periodontitis and root filled teeth in patients with periodontal treatment need. Int Endod J. 2006;39:299–308.PubMedCrossRefGoogle Scholar
  79. 79.
    Giuliana G, Ammatuna P, Pizzo G, Capone F, D’Angelo M. Occurrence of invading bacteria in radicular dentin of periodontally diseased teeth: microbiological findings. J Clin Periodontol. 1997;24:478–85.PubMedCrossRefGoogle Scholar
  80. 80.
    Gupta S, Tewari S, Tewari S, Mittal S. Effect of time lapse between endodontic and periodontal therapies on the healing of concurrent endodontic-periodontal lesions without communication: a prospective randomized clinical trial. J Endod. 2015;41:785–90.PubMedCrossRefGoogle Scholar
  81. 81.
    Killoy WJ. Local delivery of antimicrobials: a new era in the treatment of adult periodontitis. Compend Contin Educ Dent. 1999;20(Suppl. 4):13–8.. quiz 34-35PubMedGoogle Scholar
  82. 82.
    Walker C. The supplemental use of antibiotics in periodontal therapy. Compend Contin Educ Dent. 1999;20(Suppl):4–12.PubMedGoogle Scholar
  83. 83.
    Fourmousis I, Tonetti MS, Mombelli A, Lehmann B, Lang NP, Brägger U. Evaluation of tetracycline fiber therapy with digital image analysis. J Clin Periodontol. 1998;25:73–745.CrossRefGoogle Scholar
  84. 84.
    Wennström JL, Newman HN, MacNeill SR, et al. Utilisation of locally delivered doxycycline in nonsurgical treatment of chronic periodontitis: a comparative multi-centre trial of 2 treatment approaches. J Clin Periodontol. 2001;28:753–61.PubMedCrossRefGoogle Scholar
  85. 85.
    Breault LG, Schuster GS, Billman MA, et al. The effects of intracanal medicaments, filers and sealers on the attachment of human gingival fibroblasts to an exposed dentin surface free of a smear layer. J Periodontol. 1995;66:545–51.PubMedCrossRefGoogle Scholar
  86. 86.
    Cortellini P, Tonetti MS. Evaluation of the effect of tooth vitality on regenerative outcomes in infrabony defects. J Clin Periodontol. 2001;28:672–9.PubMedCrossRefGoogle Scholar
  87. 87.
    Harrington GW. The perio-endo question: differential diagnosis. Dent Clin N Am. 1979;23:673–90.PubMedGoogle Scholar
  88. 88.
    Abbott P. Endodontic management of combined endodontic-periodontal lesions. J N Z Soc Periodontol. 1998;83:15–28.Google Scholar
  89. 89.
    Nirola A. Pulpal perio relations: Interdisciplinary diagnostic approach I. J Indian Soc Periodontol. 2011;15(1):80–2.PubMedCrossRefPubMedCentralGoogle Scholar
  90. 90.
    Tseng CC, Harn WM, Chen YH, Huang CC, Yuan K, Huang PH. A new approach to the treatment of True combined Endodontic-periodontic lesions by the guided tissue regeneration technique. J Endod. 1996;22:693–6.PubMedCrossRefGoogle Scholar
  91. 91.
    Nemcovsky CE, Sculean A. Evidence-based decision making in periodontal tooth prognosis and maintenance of the natural dentition. In: Rosen E, Nemcovsky CE, Tsesis I, editors. Evidence-based decision making in dentistry. Multidisciplinary management of the natural dentition. Switzerland: Springer International Publishing; 2017. p. 39–60.CrossRefGoogle Scholar
  92. 92.
    Tonetti MS, Muller-Campanile V, Lang NP. Changes in the prevalence of residual pockets and tooth loss in treated periodontal patients during a supportive maintenance care program. J Clin Periodontol. 1998;25:1008–16.PubMedCrossRefGoogle Scholar
  93. 93.
    Tonetti MS, Steffen P, Muller-Campanile V, Suvan J, Lang NP. Initial extractions and tooth loss during supportive care in a periodontal population seeking comprehensive care. J Clin Periodontol. 2000;27:824–31.PubMedCrossRefGoogle Scholar
  94. 94.
    Holm-Pedersen P, Lang NP, Müller F. What are the longevities of teeth and oral implants? Clin Oral Implants Res. 2007;18:5–9.CrossRefGoogle Scholar
  95. 95.
    Torabinejad M, Goodacre CJ. Endodontic or dental implant therapy: the factors affecting treatment planning. J Am Dent Assoc. 2006;137(7):973–7.PubMedCrossRefGoogle Scholar
  96. 96.
    Ioannou AL, Kotsakis GA, Hinrichs JE. Prognostic factors in periodontal therapy and their association with treatment outcomes. World J Clin Cases. 2014;2(12):822–7.PubMedCrossRefPubMedCentralGoogle Scholar
  97. 97.
    Cortellini P, Prato GP, Tonetti MS. The modified papilla preservation technique. A new surgical approach for interproximal regenerative procedures. J Periodontol. 1995;6:261–6.CrossRefGoogle Scholar
  98. 98.
    Cortellini P, Stalpers G, Mollo A, Tonetti MS. Periodontal regeneration versus extraction and prosthetic replacement of teeth severely compromised by attachment loss to the apex: 5-year results of an ongoing randomized clinical trial. J Clin Periodontol. 2011;38:915–24.PubMedCrossRefGoogle Scholar
  99. 99.
    Tonetti MS, Cortellini P, Lang NP, Suvan JE, Adriaens P, Dubravec D, Fonzar A, Fourmousis I, Rasperini G, Rossi R, Silvestri M, Topoll H, Wallkamm B, Zybutz M. Clinical outcomes following treatment of human intrabony defects with GTR/bone replacement material or access flap alone. A multicenter randomized controlled clinical trial. J Clin Periodontol. 2004;31(9):770–6.Google Scholar
  100. 100.
    Atieh MA, Alsabeeha NH, Faggion CM, Duncan WJ. The frequency of peri-implant diseases: a systematic review and meta-analysis. J Periodontol. 2013;84:1586–98.PubMedGoogle Scholar
  101. 101.
    Jung RE, Zembic A, Pjetursson BE, et al. Systematic review of the survival rate and the incidence of biological, technical, and aesthetic complications of single crowns on implants reported in longitudinal studies with a mean follow-up of 5 years. Clin Oral Implants Res. 2012;23:2–21.PubMedCrossRefGoogle Scholar
  102. 102.
    Mombelli A, Müller N, Cionca N. The epidemiology of peri-implantitis. Clin Oral Implants Res. 2012;23:67–76.PubMedCrossRefGoogle Scholar
  103. 103.
    Romeo E, Storelli S. Systematic review of the survival rate and the biological, technical, and aesthetic complications of fixed dental prostheses with cantilevers on implants reported in longitudinal studies with a mean of 5 years follow-up. Clin Oral Implants Res. 2012;23:39–49.PubMedCrossRefGoogle Scholar
  104. 104.
    Chrcanovic BR, Kisch J, Albrektsson T, Wennerberg A. A retrospective study on clinical and radiological outcomes of oral implants in patients followed up for a minimum of 20 years. Clin Implant Dent Relat Res. 2018;20(2):199–207.
  105. 105.
    Fardal Ø, Grytten J. A comparison of teeth and implants during maintenance therapy in terms of the number of disease-free years and costs – an in vivo internal control study. J Clin Periodontol. 2013;40:645–51.CrossRefPubMedGoogle Scholar
  106. 106.
    Nibali L, Sun C, Akcalı A, Meng X, Tu Y-K, Donos N. A retrospective study on periodontal disease progression in private practice. J Clin Periodontol. 2017;44:290–7.PubMedCrossRefGoogle Scholar
  107. 107.
    Bröseler F, Tietmann C, Hinz AK, Jepsen S. Long-term results of periodontal regenerative therapy: a retrospective practice-based cohort study. J Clin Periodontol. 2017;44(5):520–9.PubMedCrossRefGoogle Scholar
  108. 108.
    Tonetti MS, Christiansen AL, Cortellini P. Vertical subclassification predicts survival of molars with class II furcation involvement during supportive periodontal care. J Clin Periodontol. 2017;44(11):1140–4.PubMedCrossRefGoogle Scholar
  109. 109.
    Pico-Blanco A, Castelo-Baz P, Caneiro-Queija L, Liñares-González A, Martin-Lancharro P, Blanco-Carrión J. Saving single-rooted teeth with combined endodontic-periodontal lesions. J Endod. 2016;42:1859–64.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Carlos E. Nemcovsky
    • 1
    Email author
  • José Luis Calvo Guirado
    • 2
  • Ofer Moses
    • 1
  1. 1.Department of Periodontology and Implant DentistryThe Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv UniversityTel AvivIsrael
  2. 2.Faculty of Health Sciences, Department of Oral Surgery and Implant DentistryUniversidad Católica San Antonio de Murcia (UCAM)MurciaSpain

Personalised recommendations