Time lapse between endodontic and periodontal treatments of combined periodontal-endodontic lesion: a systematic review

doi:10.7518/hxkq.2018.02.010

Abstract

Abstract:

Objective This study aims to evaluate the time lapse between the endodontic and periodontal treatments of the combined periodontal-endodontic lesion to guide the clinical treatment. Methods A systemic literature search was performed in articles published from 1980 to March 2017 using the electronic databases, including PubMed, EMbase, Cochrane, Web of Science, CNKI, CBM, and Wanfang Databases. Results After screening, two randomized controlled trials, two prospective case series studies, and eight case reports were ultimately included. All clinical studies and case reports were treated with root canal therapy and periodontal nonsurgical or periodontal surgical treatment, with root canal therapy as the initial treatment step. Changes in the periodontal probing depth and attachment loss were reported in all clinical studies and case reports. Conclusion An observational period between the endodontic and periodontal nonsurgical treatments may not be required. However, given that the quality of several included studies was limited, and the number of randomized controlled trials was small, a large number of randomized controlled trials are needed to verify this result.

Key words: combined periodontal-endodontic lesion, periodontal treatment, root canal therapy, time lapse, syste-matic review

CLC Number:

R781.4

Yue Jin, Bin Chen, Yanhong Ni, Fuhua. Yan. Time lapse between endodontic and periodontal treatments of combined periodontal-endodontic lesion: a systematic review[J]. West China Journal of Stomatology, 2018, 36(2): 167-173.

Figures/Tables 3

Fig 1

Tab 1

Tab 2

References 31

[1]	Armitage GC.Development of a classification system for periodontal diseases and conditions[J]. Ann Periodontol, 1999, 4(1):1-6.
[2]	Al-Fouzan KS.A new classification of endodontic-perio-dontal lesions[J]. Int J Dent, 2014:919173.
[3]	Vakalis SV, Whitworth JM, Ellwood RP, et al.A pilot study of treatment of periodontal-endodontic lesions[J]. Int Dent J, 2005, 55(5):313-318.
[4]	Paul BF, Hutter JW.The endodontic-periodontal continuum revisited: new insights into etiology, diagnosis and treat-ment[J]. J Am Dent Assoc, 1997, 128(11):1541-1548.
[5]	Chapple IL, Lumley PJ.The periodontal-endodontic inter-face[J]. Dent Update, 1999, 26(8):331-336.
[6]	Giuliana G, Ammatuna P, Pizzo G, et al.Occurrence of in-vading bacteria in radicular dentin of periodontally diseased teeth: microbiological findings[J]. J Clin Periodontol, 1997, 24(7):478-485.
[7]	胡立志. 牙周牙髓联合病变的诊治研究新进展[J]. 医学理论与实践, 2016, 29(16):2172-2174.
	Hu LZ.New progress in the diagnosis and treatment of the combined periodontal-endodontic lesion[J]. J Med Theory Pract, 2016, 29(16):2172-2174.
[8]	周伟, 陈斌, 赵俊杰, 等. 牙周牙髓联合病变牙周治疗时机选择研究[J]. 口腔医学研究, 2016, 32(6):601-604.
	Zhou W, Chen B, Zhao JJ, et al.Research on the periodontal treatment timing for combined periodontal-endodontic lesions[J]. J Oral Sci Res, 2016, 32(6):601-604.
[9]	Higgins J, Green S. Cochrane handbook for systematic reviews of interventions. Version 5.1.0[DB/OL]. [2017-05-30]. .
[10]	NICE. Appendix 4 quality of case series form[EB/OL].[2017-05-30]. .
[11]	Gupta S, Tewari S, Tewari S, et al.Effect of time lapse be-tween endodontic and periodontal therapies on the healing of concurrent endodontic-periodontal lesions without com-munication: a prospective randomized clinical trial[J]. J En-dod, 2015, 41(6):785-790.
[12]	孙江, 刘琼. Bio-oss骨胶原植骨手术在牙周-牙髓联合病变治疗中的应用[J]. 南方医科大学学报, 2009, 29(9):1905-1906.
	Sun J, Liu Q.Bio-oss collagen bone grafting in the treat-ment of endodontic-periodontic lesion[J]. J South Med Univ, 2009, 29(9):1905-1906.
[13]	Zehnder M.Endodontic infection caused by localized aggres-sive periodontitis: a case report and bacteriologic evaluation[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2001, 92(4):440-445.
[14]	Fahmy MD, Luepke PG, Ibrahim MS, et al.Treatment of a periodontic-endodontic lesion in a patient with aggressive periodontitis[J]. Case Rep Dent, 2016:7080781.
[15]	Oh SL, Fouad AF, Park SH.Treatment strategy for guided tissue regeneration in combined endodontic-periodontal lesions: case report and review[J]. J Endod, 2009, 35(10):1331-1336.
[16]	Zubery Y, Kozlovsky A.Two approaches to the treatment of true combined periodontal-endodontal lesions[J]. J Endod, 1993, 19(8):414-416.
[17]	Azaripour A, Willershausen I, Kämmerer P, et al.Post-endodontic treatment periodontal surgery: a case report[J]. Quintessence Int, 2013, 44(2):123-126.
[18]	Karunakar P, Prasanna JS, Jayadev M, et al.Platelet-rich fibrin, “a faster healing aid” in the treatment of combined lesions: a report of two cases[J]. J Indian Soc Periodontol, 2014, 18(5):651-655.
[19]	Narang S, Narang A, Gupta R.A sequential approach in treatment of perio-endo lesion[J]. J Indian Soc Periodontol, 2011, 15(2):177-180.
[20]	Pico-Blanco A, Castelo-Baz P, Caneiro-Queija L, et al.Saving single-rooted teeth with combined endodontic-periodontal lesions[J]. J Endod, 2016, 42(12):1859-1864.
[21]	Zehnder M, Gold SI, Hasselgren G.Pathologic interactions in pulpal and periodontal tissues[J]. J Clin Periodontol, 2002, 29(8):663-671.
[22]	Blomlöf L, Lindskog S, Hammarström L.Influence of pulpal treatments on cell and tissue reactions in the marginal perio-dontium[J]. J Periodontol, 1988, 59(9):577-583.
[23]	Lima LA, Anderson GB, Wang MM, et al.Healing of in-trabony defects and its relationship to root canal therapy. A histologic and histometric study in dogs[J]. J Periodontol, 1997, 68(3):240-248.
[24]	Seo BM, Miura M, Gronthos S, et al.Investigation of mul-tipotent postnatal stem cells from human periodontal liga-ment[J]. Lancet, 2004, 364(9429):149-155.
[25]	Nakib NM, Bissada NF, Simmelink JW, et al.Endotoxin penetration into root cementum of periodontally healthy and diseased human teeth[J]. J Periodontol, 1982, 53(6):368-378.
[26]	Ciantar M.Time to shift: from scaling and root planing to root surface debridement[J]. Prim Dent J, 2014, 3(3):38-42.
[27]	Rotstein I, Simon JH.Diagnosis, prognosis and decision-making in the treatment of combined periodontal-endodontic lesions[J]. Periodontol 2000, 2004, 34:165-203.
[28]	Ng YL, Mann V, Rahbaran S, et al.Outcome of primary root canal treatment: systematic review of the literature—part 1. Effects of study characteristics on probability of success[J]. Int Endod J, 2007, 40(12):921-939.
[29]	李宇飞, 田慧颖, 王晓霞. 初次根管治疗愈合率和影响因素分析[J]. 华西口腔医学杂志, 2012, 30(1):61-64.
	Li YF, Tian HY, Wang XX.Analysis of initial endodontic treatment outcome and relevant factors[J]. West Chin J Stomatol, 2012, 30(1):61-64.
[30]	Farzaneh M, Abitbol S, Lawrence HP, et al.Treatment out-come in endodontics—the Toronto study. Phase Ⅱ: initial treatment[J]. J Endod, 2004, 30(5):302-309.
[31]	汪小彤, 孙超, 朱洁, 等. 应用CBCT评判根管治疗失败原因[J]. 口腔医学, 2015, 35(5):373-375.
	Wang XT, Sun C, Zhu J, et al.Application of CBCT in eva-luating and analyzing causes for failure in root canal therapy[J]. Stomatology, 2015, 35(5):373-375.

作者	年份	研究类型	性别		年龄/岁	最初牙数/		牙齿类型		基线时平均PD/mm			基线时平均AL/mm
作者	年份	研究类型	（男/女）		年龄/岁	最终牙数		牙齿类型		试验组		对照组	试验组	对照组
周伟等^[8]	2016	RCT	68/64		31~73	138/99		第一、第二磨牙		9.17±1.90		9.05±2.17	10.89±2.01	10.64±2.30
Gupta等^[11]*	2015	RCT	14/17		26~65,平	50/37		磨牙、前磨牙、		4.18±0.55		4.36±0.60	4.57±0.89	5.27±1.48
					均45.5			切牙
Vakalis等^[3]	2005	前瞻性病例系	3/6		平均49	9/8		磨牙、前磨牙、		4.79±1.16			7.31±1.41
		列研究						尖牙、切牙
孙江等^[12]	2009	前瞻性病例系	18/12		28~53	37		磨牙、前磨牙		6.59±0.203			8.65±0.188
		列研究
作者	治疗程序						随访时		失访例数		治疗后平均PD/mm		治疗后平均AL/mm
作者	试验组			对照组			间/月		失访例数		试验组	对照组	试验组	对照组
周伟等^[8]	RCT+S—4~6周—SRP			RCT+S—1周—SRP			3		10（拔除）;		6.20±2.80	7.59±2.63	8.60±2.76	9.91±2.86
									29（未计入）
							6				6.14±2.91	7.72±3.47	9.14±2.57	9.09±2.54
							12				7.00±2.16	6.50±2.12	9.75±2.40	9.60±1.89
Gupta等^[11]*	S—1周—RCT1+RCT2			S—1周—RCT1+RCT2+			3		实验组：7;		0.21±0.27	1.35±0.72	0.14±0.32	1.36±0.72
	—10 d—RCT3—3月			SRP—10 d—RCT3					对照组：6
	—SRP						6				1.48±0.58	1.39±1.24	1.47±0.56	1.32±1.17
							9				1.58±0.59		1.56±0.59
Vakalis等^[3]	RCT+S—1月—SRP						3		1（拔除）		3.87±1.64		6.33±1.58
孙江等^[12]	RCT—1周—S+SRP—						3		3		3.88±0.151		7.38±0.152
	4周—PS—AB（1周）
							6		8		2.83±0.149		6.79±0.182
							12		18		2.42±0.233		6.58±0.268

作者	年份/年	性别	年龄/岁	牙位	基线时PD/mm		基线时AL/mm
Zehnder^[13]	2001	男	28	15	颊侧近中、中部、远中：4、4、8;腭侧近中、
					中部、远中：>10、>10、>10
Fahmy等^[14]	2016	女	35	36	远中：12		平均：2.7
Oh等^[15]	2009	女	50	16	9
Zubery等^[16]	1993	女	25	36	>10
Azaripour等^[17]	2013	男	65	34	远中：>14
Karunakar等^[18]	2014	男	24	46	10
		女	32	44	8
Narang等^[19]	2011	男	22	46	VPD：4;HPD：6
Pico-Blanco等^[20]	2016			43	12		17
				21	13		16
				21	8		13
				11	6		15
				11	10		11
作者	治疗程序				随访时间/月	治疗后PD减少量/mm	治疗后AL减少量/mm
Zehnder^[13]	RCT1+SRP—1周—RCT2—1周—				6	颊侧近中、中部、远中：2、	颊侧近中、中部、远中：2、2、3;
	RCT3—4月—PS					2、3;腭侧近中、中部、远	腭侧近中、中部、远中：>6、>3、
						中：>8、>6、>5	>3
Fahmy等^[14]	RCT1+RCT2+SRP—1周—RCT3—				6		远颊9;远舌8
	4周—PS
					24	远中：8	平均1.2
Oh等^[15]	RCT+SRP—1月—GTR+SRP—AB				10	3
	（1周） —10月—GTR
					20	6
Zubery等^[16]	RCT—SRP—12月—PS				18	>8
Azaripour等^[17]	RCT—6月—PS				24	远中：10
Karunakar等^[18]	AD—SRP—AB（5 d）;RCT—				9	6
	3月—PS
	SRP—RCT—3月—PS				9	5
Narang等^[19]	RCT—3月—PS				9	3
Pico-Blanco等^[20]	RCT—S—至少3个月—PS—AB				14	9	5
	（1周）
					24	10	9
					36	5	4
					72	4	9
					204	7	6