Autumn 2016 (Volume 5, Issue 4)
In our last issue of the year we’ll look at the classification of endodontic-periodontic lesions. The classification described here by Simon and colleagues is perhaps the most popular one used today. Hope you all have a wonderful holidays!
Simon JHS, Glick DH, Frank AL. The Relationship of Endodontic-Periodontic Lesions. J Perio 1972;43:202-8.
This classic review article classifies endodontic-periodontic lesions and provides a description of their diagnosis and treatment.
Primary Endo Lesions are due to a necrotic pulp that results in a sinus tract that can be probed through the sulcus. The crestal bone is otherwise normal and lesion is expected to heal following root canal therapy.
Primary Endo Secondary Perio Lesions occur when a Primary Endo lesion is left untreated for a period of time and plaque and calculus form in the lesion resulting in periodontal disease. These lesions require both endodontic and periodontal treatment.
Primary Perio Lesions are due solely to periodontal disease. The pulp tests vital so root canal therapy is not indicated. Treatment and prognosis is dependent purely on periodontal considerations.
Primary Perio Secondary Endo Lesions occur when the periodontal disease has progressed far enough to cause pulp necrosis. This can occur when the major foramen are involved in the periodontal defect. Treatment involves both endodontic and periodontal care. However, prognosis is likely compromised due to the severe periodontal disease.
True Combined Lesions occur when an endodontic lesion from the apex and a periodontal defect from the crestal bone merge somewhere along the root surface. Treatment involves root canal therapy followed by periodontal treatment.
Concomitant Lesions exist when a tooth has both endodontic and periodontal lesions that have not merged. They can be viewed and treated independently as appropriate. Given enough time, a Concomitant Lesion can become a True Combined Lesion if and when the endodontic and periodontic lesions merge. [Note that this type of lesion was described by Belk and Gutmann in 1990, and not in Simon’s original classification.]
SUMMARY: Endodontic-periodontic lesions can be classified as Primary Endo, Primary Endo Secondary Perio, Primary Perio, Primary Perio Secondary Endo, True Combined, and Concomitant Lesions.