Endodontic–Periodontal Lesions: Biological Basis, Diagnostic Challenges, and Contemporary Management Strategies

Abstract

The dental pulp and periodontium are intimately connected through anatomical structures such as the apical foramen, lateral and accessory canals, and dentinal tubules, creating pathways for the bidirectional spread of infection and inflammation. This close relationship can result in endodontic–periodontal lesions, which often present significant diagnostic and therapeutic challenges due to overlapping clinical and radiographic features. This review aims to examine the etiopathogenesis, classification, diagnostic considerations, and contemporary management approaches for endodontic–periodontal lesions. A narrative review of classical and current literature was conducted, focusing on the anatomical and biological interrelationship between pulpal and periodontal tissues, microbial interactions, disease progression, and evidence-based treatment protocols. The reviewed literature indicates that endodontic infections commonly produce secondary periodontal manifestations through the dissemination of microorganisms and their by-products along established anatomical pathways, while advanced periodontal disease may, under certain circumstances, adversely affect pulpal health. Accurate diagnosis requires a comprehensive assessment incorporating pulp vitality testing, periodontal examination, probing patterns, radiographic evaluation, and correlation of clinical findings. Successful treatment outcomes depend on correctly identifying the primary source of infection and implementing an appropriate treatment sequence. In most cases, endodontic therapy should be initiated before periodontal intervention to facilitate healing, permit reassessment of periodontal status, and guide the need for additional periodontal treatment. A thorough understanding of the endodontic–periodontal relationship remains essential for predictable diagnosis, treatment planning, and long-term prognosis.