Comprehensive Dentistry: A Multidisciplinary Strategy for Periodontal-Endodontic Lesions and Restorative Care
29/08/2025
Fitim Shabani
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The management of periodontal-endodontic lesions represents a complex clinical challenge requiring a comprehensive understanding of the interactions between the periodontium, the pulp, and restorative dental structures. These lesions often present with overlapping symptoms and pathologies that demand an integrated approach for accurate diagnosis and effective treatment. In recent years, a multidisciplinary strategy involving periodontics, endodontics, and restorative dentistry has become essential in addressing the multifaceted nature of these lesions. By combining expertise from these specialized fields, clinicians can devise treatment plans that not only eradicate infection and inflammation but also preserve tooth structure and restore function and aesthetics. This article explores the principles and benefits of a collaborative approach in managing periodontal-endodontic lesions, emphasizing the importance of coordinated care to optimize patient outcomes and long-term dental health.
Fig. 1
Clinical data
Second maxillary premolar left presenting with a fractured crown, accompanied by clinical signs of pulpal necrosis and localized deep periodontal pockets.
Dg: Periodontal-endodontic lesion connected to the crown fracture.
Treatment plan : multidisciplinary treatment approach.
Fig. 2
Initial situation of the case.
Fig. 3
Periodontal approach
Removal of infected tissues and disinfection.
Fig. 4
Endodontic approach.
Fig. 5
Overfibers
Hi-Rem Post
Hi-Rem posts are typically made from high-strength glass or quartz fibers embedded in a resin matrix. This combination yields excellent flexibility and strength, more closely matching the elastic modulus of natural dentin compared to metal posts.
Fig. 6
Biomechanical Compatibility:
The elastic modulus of fiber posts like Hi-Rem is similar to that of dentin, which helps distribute occlusal forces more evenly. This reduces the risk of root fracture - a common complication with rigid metal posts.
Fig. 7
Hi-Rem Endodontic Post, has the great advantage to be easily removable when it is necessary.
The central longitudinal axis of Hi-Rem Endodontic Post is made of soft polymer macro-fiber, placing in this position doesn’t affect the resistance of the post, because the stresses are minimal (neutral axis)
Fig. 8
Final X-ray
Fig. 9
Final result, after Crown cementation.
Conclusions
The effective management of periodontal-endodontic lesions hinges on a multidisciplinary approach that integrates periodontics, endodontics, and restorative dentistry. By understanding the complex interplay between the periodontium, pulp, and dental restorations, clinicians can achieve accurate diagnosis and tailor comprehensive treatment plans. This collaborative strategy not only addresses infection and inflammation effectively but also ensures the preservation of tooth structure and restoration of function and aesthetics, ultimately enhancing patient outcomes and promoting long-term oral health.
Bibliography
- Simon, J. H., Glick, D. H., & Frank, A. L. (2021). The relationship of endodontic-periodontic lesions. Journal of Endodontics, 47(12), 1745-1757.
- Karabucak, B., Bae, H., & Brennan, P. (2020). Multidisciplinary management of combined periodontal-endodontic lesions. Dental Clinics of North America, 64(3), 435-457.
- Goodacre, C. J., & Spolnik, K. J. (2013). Endodontics and restorative dentistry: an introduction to diagnosis, treatment planning, and clinical procedures. Quintessence Publishing.
- Torabinejad, M., & Walton, R. E. (2009). Endodontics: Principles and Practice (4th ed.). Saunders.
