Implementing the 2017 EFP/AAP Periodontal Disease Classification in The Diagnosis and Management of Endo-Periodontal Lesions: A Case Report

Hock Siang Chua; Zhi Kuan Saw; Shahida Mohd-Said

doi:10.24815/cdj.v16i1.36416

Implementing the 2017 EFP/AAP Periodontal Disease Classification in The Diagnosis and Management of Endo-Periodontal Lesions: A Case Report

Hock Siang Chua, Zhi Kuan Saw, Shahida Mohd-Said

Abstract

Endo-periodontal lesions (EPL), characterised by the involvement of both pulpal and periodontal tissues, present diagnostic and therapeutic challenges in dental practice. This case report highlights the successful management of an EPL in a 52-year-old female patient with the guidance of the 2017 EFP/AAP Classification. Tooth 43 was incidentally found to be necrotic with symptomatic apical periodontitis and was subsequently root canal treated. However, at 15 months post-obturation, the tooth was presented with acute periodontal swelling at the buccal gingiva with deep pockets, bleeding-on-probing, calculus deposition, and periapical radiolucency. Using the 2017 EFP/AAP Classification, the diagnosis of EPL without root damage in non-periodontitis patients with Grade III was made. This report facilitates better and more accurate diagnosis-making for effective EPL treatment outcomes.

Keywords

Endo-periodontal lesion; EFP/AAP Classification; Periodontal abscess; Root surface debridement

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References

Herrera D, Retamal-Valdes B, Alonso B, Feres M. Acute periodontal lesions (periodontal abscesses and necrotising periodontal diseases) and endo-periodontal lesions. J Periodontol. 2018;89(July 2017):S85–102.

Papapanou PN, Sanz M, Buduneli N, Dietrich T, Feres M, Fine DH, et al. Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Clin Periodontol. 2018;45(December 2017):S162–70.

Lindhe J, Ranney R, Lamster I, Charles A, Chung C, Flemmig T, et al. 1999 International Workshop for a Classification of Periodontal Diseases and Conditions. Papers. Oak Brook, Illinois, October 30–November 2, 1999. Consensus Report: Chronic Periodontitis. Ann Periodontol. 1999;4(1):38–38.

Simon JH, Glick DH, Frank AL. The relationship of endodontic-periodontic lesions. J Periodontol. 1972;43(4):202–8.

M T, M T. Endodontic and periodontal interrelationships. In: RE W, M T, editors. Principles and Practice of Endodontics. 2nd ed. 1996.

G. Caton J, Armitage G, Berglundh T, Chapple ILC, Jepsen S, S. Kornman K, et al. A new classification scheme for periodontal and peri-implant diseases and conditions – Introduction and key changes from the 1999 classification. J Clin Periodontol. 2018;45(March):S1–8.

Glickman G. AAE consensus conference recommended diagnostic terminology. J Endod. 2009;35(12):1634.

Tsesis I, Rosen E, Tamse A, Taschieri S, Kfir A. Diagnosis of vertical root fractures in endodontically treated teeth based on clinical and radiographic indices: A systematic review. J Endod [Internet]. 2010;36(9):1455–8. Available from: http://dx.doi.org/10.1016/j.joen.2010.05.003

Oktawati S, Siswanto H, Mardiana A, Supiaty, Neormansyah I, Basir I. Endodontic–periodontic lesion management: A systematic review. Med Clin Pract [Internet]. 2020;3:100098. Available from: https://doi.org/10.1016/j.mcpsp.2020.100098

Wan L, Lu HB, Xuan DY, Yan YX, Zhang JC. Histological changes within dental pulps in teeth with moderate-to-severe chronic periodontitis. Int Endod J. 2015;48(1):95–102.

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(10):729–34.

Ramachandra SS, Gupta VV, Woodford V, Malhotra N. Isolated periodontal pockets: a clinical review. Dent Update. 2023;50(7):707–9.

British Society of Periodontolgy. The Good Practitioner’s Guide to Periodontology. Ian N, editor. 2006.

Haueisen H, Heidemann D. Hemisection for treatment of an advanced endodontic-periodontal lesion: a case report. Int Endod J. 2002;35(6):557–72.

Abbott P V., Salgado JC. Strategies for the endodontic management of concurrent endodontic and periodontal diseases. Aust Dent J. 2009;54:S70–85.

Usui M, Onizuka S, Sato T, Kokabu S, Ariyoshi W, Nakashima K. Mechanism of alveolar bone destruction in periodontitis — Periodontal bacteria and inflammation. Jpn Dent Sci Rev [Internet]. 2021;57:201–8. Available from: https://doi.org/10.1016/j.jdsr.2021.09.005

Fan X, Xu X, Yu S, Liu P, Chen C, Pan Y, et al. Prognostic Factors of Grade 2-3 Endo-Periodontal Lesions Treated Nonsurgically in Patients with Periodontitis: A Retrospective Case-Control Study. Biomed Res Int. 2020;2020.

DOI: https://doi.org/10.24815/cdj.v16i1.36416