Influence of Endodontic Treatments on Periodontal Health: A Literature Review
DOI:
https://doi.org/10.29166/odontologia.vol27.n3.esp.2025-e8861Keywords:
Periodontal Diseases, Endodontics, Periodontics, Periapical Periodontitis, Oral HealthAbstract
Introduction: Although the dental pulp and periodontium are distinct structures, they maintain an anatomical connection that allows for the bidirectional spread of infections. This interrelationship favors endo-periodontal lesions (EPLs), in which pulpal and periodontal infections mutually influence each other. The literature reports a higher prevalence of apical periodontitis in endodontically treated teeth, especially when deficiencies exist in the filling or crown restoration. Objective: To analyze the influence of endodontic treatments on periodontal health, addressing their anatomical and pathophysiological relationship, diagnosis, treatment, and prevention of EPLs. Materials and Methods: A qualitative and documentary literature review was conducted using PubMed, Scopus, Web of Science, SciELO, and Google Scholar, including articles published between 2015 and 2025 in English, Spanish, or Portuguese. Of the 55 studies identified, 14 were selected for critical analysis based on the inclusion and exclusion criteria. Results: The endodontic treatment technique is crucial for preventing apical periodontitis. The differential diagnosis of EPLs requires vitality tests, CBCT, and, in some cases, microbiological techniques. The combination of endodontic and periodontal therapy, complemented with platelet-rich fibrin, bone grafts, and mineral trioxide aggregate, enhances tissue regeneration, reduces inflammation, and improves prognosis. Conclusion: The successful management of EPLs requires comprehensive diagnosis, infection control, and interdisciplinary collaboration. The application of regenerative therapies and preventive strategies optimizes the preservation of dental and periodontal structures, contributing to predictable and sustainable clinical outcomes.
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References
Persoon IF, Özok AR. Definitions and epidemiology of endodontic infections. Curr Oral Health Rep. el 8 de noviembre de 2017;4(4):278–85.
Pirani C, Camilleri J. Effectiveness of root canal filling materials and techniques for treatment of apical periodontitis: A systematic review. Int Endod J. octubre de 2023;56 Suppl 3(S3):436–54.
Huumonen S, Suominen AL, Vehkalahti MM. Prevalence of apical periodontitis in root filled teeth: findings from a nationwide survey in Finland. Int Endod J. marzo de 2017;50(3):229–36.
Doğramacı EJ, Rossi-Fedele G. Patient-related outcomes and Oral Health-Related Quality of Life in endodontics. Int Endod J. marzo de 2023;56 Suppl 2:169–87.
Galler KM, Weber M, Korkmaz Y, Widbiller M, Feuerer M. Inflammatory response mechanisms of the dentine-pulp complex and the periapical tissues. Int J Mol Sci. el 2 de febrero de 2021;22(3):1480.
Sălceanu M, Dascălu C, Melian A, Giuroiu C, Antohi C, Concita C, et al. Assessment of periodontitis risk factors in endodontically treated teeth: A cross-sectional study. Diagnostics (Basel). el 6 de septiembre de 2024;14(17):1972.
Craveiro MA, Fontana CE, de Martin AS, Bueno CE da S. Influence of coronal restoration and root canal filling quality on periapical status: clinical and radiographic evaluation. J Endod. junio de 2015;41(6):836–40.
Thampibul P, Jantarat J, Arayasantiparb R. Post-treatment apical periodontitis related to the technical quality of root fillings and restorations in Thai population. Aust Endod J. agosto de 2019;45(2):163–70.
Sebring D, Buhlin K, Lund H, Norhammar A, Rydén L, EndoReCo, et al. Endodontic inflammatory disease and future cardiovascular events and mortality: A report from the PAROKRANK study. J Endod. agosto de 2024;50(8):1073-1081.e3.
Pedro FM, Marques A, Pereira TM, Bandeca MC, Lima S, Kuga MC, et al. Status of endodontic treatment and the correlations to the quality of root canal filling and coronal restoration. J Contemp Dent Pract. el 1 de octubre de 2016;17(10):830–6.
Connert T, Truckenmüller M, ElAyouti A, Eggmann F, Krastl G, Löst C, et al. Changes in periapical status, quality of root fillings and estimated endodontic treatment need in a similar urban German population 20 years later. Clin Oral Investig. marzo de 2019;23(3):1373–82.
Jakovljevic A, Nikolic N, Jacimovic J, Pavlovic O, Milicic B, Beljic-Ivanovic K, et al. Prevalence of apical periodontitis and conventional nonsurgical root canal treatment in general adult population: An updated systematic review and meta-analysis of cross-sectional studies published between 2012 and 2020. J Endod. octubre de 2020;46(10):1371-1386.e8.
El Ouarti I, Chala S, Sakout M, Abdallaoui F. Prevalence and risk factors of Apical periodontitis in endodontically treated teeth: cross-sectional study in an Adult Moroccan subpopulation. BMC Oral Health. el 17 de marzo de 2021;21(1):124.
Maslamani M, Khalaf M, Mitra A. Association of quality of coronal filling with the outcome of endodontic treatment: A follow-up study. Dent J. el 11 de enero de 2017;5(1):5.
Segura-Egea JJ, Martín-González J, Castellanos-Cosano L. Endodontic medicine: connections between apical periodontitis and systemic diseases. Int Endod J. octubre de 2015;48(10):933–51.
Tuthill JC, Azim E. Proprioception. Curr Biol. el 5 de marzo de 2018;28(5):R194–203.
Héroux ME, Butler AA, Robertson LS, Fisher G, Gandevia SC. Proprioception: a new look at an old concept. J Appl Physiol. el 1 de marzo de 2022;132(3):811–4.
Siqueira JF Jr, Silva WO, Romeiro K, Gominho LF, Alves FRF, Rôças IN. Apical root canal microbiome associated with primary and posttreatment apical periodontitis: A systematic review. Int Endod J. agosto de 2024;57(8):1043–58.
Karamifar K, Tondari A, Saghiri MA. Endodontic periapical lesion: An overview on the etiology, diagnosis and current treatment modalities. Eur Endod J. el 14 de julio de 2020;5(2):54–67.
Tibúrcio-Machado CS, Michelon C, Zanatta FB, Gomes MS, Marin JA, Bier CA. The global prevalence of apical periodontitis: a systematic review and meta-analysis. Int Endod J. mayo de 2021;54(5):712–35.
Gulabivala K, Ng YL. Factors that affect the outcomes of root canal treatment and retreatment-A reframing of the principles. Int Endod J. marzo de 2023;56 Suppl 2(S2):82–115.
Hienz SA, Paliwal S, Ivanovski S. Mechanisms of bone resorption in periodontitis. J Immunol Res. el 3 de mayo de 2015;2015:615486.
Ruetters M, Kim T-S, Krisam J, El-Sayed S, ElSayed N. Effect of endodontic treatment on periodontal healing of grade 3 endo-periodontal lesions without root damage in periodontally compromised patients-a retrospective pilot study. Clin Oral Investig. abril de 2021;25(4):2373–80.
Rotstein I. Interaction between endodontics and periodontics. Periodontol 2000. junio de 2017;74(1):11–39.
Kuoch P, Bonte E. Endoperiodontal lesions and Chicago’s new classification of periodontal and Peri-implant diseases and conditions. J Contemp Dent Pract. el 19 de agosto de 2020;21(7):798–802.
Alanazi AH, Mohammedkamel AM, Alharbi KA, Abdulhamid Khojah M, Feddah KM, Fayyumi SH. The interface of endodontics and periodontics: Managing periapical and periodontal lesions. JOURNAL OF HEALTHCARE SCIENCES. 2024;04(12):683–9.
Takahashi K, Yamazaki K, Yamazaki M, Kato Y, Baba Y. Personalized medicine based on the pathogenesis and risk assessment of endodontic-periodontal lesions. J Pers Med. el 10 de octubre de 2022;12(10):1688.
Gilyazeva V. V. , Khanova I. A. , Nikitina L. I. Endoperiodontal immune response in a chronic lesion. 2020; Disponible en: https://iajps.com/pdf/february2020/48.IAJPS48022020.pdf
García-Tuñón-Pérez P, Fernández-Jiménez A, Lafuente-Ibañez-de-Mendoza I, Estefanía-Fresco R, Marichalar-Mendia X, García-De-La-Fuente A-M. Endoperiodontal lesions: diagnosis first, then treatment and not always tooth extraction: a cross-sectional survey in Spain and a proposal of a clinical treatment protocol. J Clin Exp Dent. enero de 2024;16(1):e32–41.
Allan P, Brusca MI, Garzon ML, Ferreira AV. Literature review on endoperiodontal lesions: diagnosis, treatment and prognosis. Health Leadership and Quality of Life. el 31 de diciembre de 2023;2:296.
Díaz-Faes L, Fernández-Somoano A, Magán-Fernández A, Mesa F. Efficacy of regenerative therapy in aggressive periodontitis: a systematic review and meta-analysis of randomised controlled clinical trials. Clin Oral Investig. abril de 2020;24(4):1369–78.
Dembowska E, Jaroń A, Homik-Rodzińska A, Gabrysz-Trybek E, Bladowska J, Trybek G. Comparison of the treatment efficacy of endo-perio lesions using a standard treatment protocol and extended by using a diode laser (940 nm). J Clin Med. el 3 de febrero de 2022;11(3):811.
Zholdassova NZ, Amanzholkyzy A, Kaikan AI, Isbulatov YS, Nurtileuova AM. Efficacy of minimally invasive therapy and laser therapy in the comprehensive treatment of endoperiodontal lesions. Pol Ann Med [Internet]. 2021; Disponible en: http://dx.doi.org/10.29089/2021.21.00189
Pace R, Di Gianfilippo R, Franceschi D, Pini Prato G. A clinical dilemma: Performing or avoiding root instrumentation in the treatment of the acute phase of endodontic-periodontal lesions? A case report. Clinic Adv Periodontics [Internet]. el 10 de junio de 2024; Disponible en: http://dx.doi.org/10.1002/cap.10297
Duncan HF, Kirkevang L-L, Peters OA, El-Karim I, Krastl G, Del Fabbro M, et al. Treatment of pulpal and apical disease: The European Society of Endodontology (ESE) S3-level clinical practice guideline. Int Endod J. octubre de 2023;56 Suppl 3(S3):238–95.
Predin Djuric N, Van der Vyver PJ, Vorster M, Vally ZI. Factors influencing apical debris extrusion during endodontic treatment - A review of the literature. SADJ. el 1 de febrero de 2021;76(1):28–36.
Ordinola-Zapata R, Noblett WC, Perez-Ron A, Ye Z, Vera J. Present status and future directions of intracanal medicaments. Int Endod J. mayo de 2022;55 Suppl 3(S3):613–36.
Scannapieco FA, Gershovich E. The prevention of periodontal disease-An overview. Periodontol 2000. octubre de 2020;84(1):9–13.
Kwon T, Lamster IB, Levin L. Current concepts in the management of periodontitis. Int Dent J. diciembre de 2021;71(6):462–76.
Kumari R, Suhagia B, Maheshwari R, Singh M. Microbiological insights and diagnostic approaches in endo-perio lesions. J Pharm Bioallied Sci. mayo de 2025;17(Suppl 1):S339–41.
Gomes BPF de A, Herrera DR. Etiologic role of root canal infection in apical periodontitis and its relationship with clinical symptomatology. Braz Oral Res. el 18 de octubre de 2018;32(suppl 1):e69.
Chen B, Zhu Y, Lin M, Zhang Y, Li Y, Ouyang X, et al. Expert consensus on the diagnosis and therapy of endo-periodontal lesions. Int J Oral Sci. el 1 de septiembre de 2024;16(1):55.
Fang F, Gao B, He T, Lin Y. Efficacy of root canal therapy combined with basic periodontal therapy and its impact on inflammatory responses in patients with combined periodontal-endodontic lesions. Am J Transl Res. el 15 de diciembre de 2021;13(12):14149–56.
Tewari S, Sharma G, Tewari S, Mittal S, Bansal S. Effect of immediate periodontal surgical treatment on periodontal healing in combined endodontic-periodontal lesions with communication-A randomized clinical trial. J Oral Biol Craniofac Res. mayo de 2018;8(2):105–12.
Gautam S, Galgali SR, Sheethal HS, Priya NS. Pulpal changes associated with advanced periodontal disease: A histopathological study. J Oral Maxillofac Pathol. enero de 2017;21(1):58–63.
Goyal L, Gupta N, Gupta ND. Autologous platelet-rich derivatives along with alloplastic bone substitute in the management of complex perio-endo cases. J Indian Soc Periodontol. marzo de 2020;24(2):182–5.
AlJasser R, Bukhary S, AlSarhan M, Alotaibi D, AlOraini S, Habib SR. Regenerative therapy modality for treatment of true combined endodontic-periodontal lesions: A randomized controlled clinical trial. Int J Environ Res Public Health. el 8 de junio de 2021;18(12):6220.
Kyaw MS, Kamano Y, Yahata Y, Tanaka T, Sato N, Toyama F, et al. Endodontic regeneration therapy: Current strategies and tissue engineering solutions. Cells [Internet]. el 12 de marzo de 2025;14(6). Disponible en: http://dx.doi.org/10.3390/cells14060422
Del Fabbro M, Corbella S, Sequeira-Byron P, Tsesis I, Rosen E, Lolato A, et al. Endodontic procedures for retreatment of periapical lesions. Cochrane Database Syst Rev. el 19 de octubre de 2016;10(12):CD005511.
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Copyright (c) 2025 María Soledad Salvatierra Valle, Tania Priscila Fernández Muñoz, Diego Xavier Toral Aguilera, Priscila Alexandra León Castro

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