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The aim of the study was to collect data about the prevalence and risk factors of apical periodontitis in a population of endodontically treated patients. The study group included 151 patients (52 males, 99 females; mean age 48.36 ± 15.708 yrs.) with 391 endodontically treated teeth (mean follow-up of 5.25 ± 1.759 yrs.). According to the initial tooth diagnosis, root-filled teeth were divided into Group A, root-filled teeth treated for pulpitis or for the purpose of prosthetic pulpectomies (vital pulp group), and Group B, root-filled teeth with non-vital pulp (necrotic pulp). Clinical and radiographic evaluation of the root and its periapical area were performed to establish the success/failure of endodontic therapy, the quality of the root canal fillings (length, density, taper), and coronal restoration. The presence of recurrent caries, periodontal pathology, or endo-periodontal lesions were also recorded. Univariate and multivariate analyses were used to determine the risk factors for apical periodontitis and calculate their odds ratios (ORs). For the root-filled vital pulp tooth group, the highest risks for apical periodontitis are associated with inadequate homogeneity (OR 30.938), periodontitis (OR 9.226), and over-filling (OR 8.800). For the root-filled non-vital pulp tooth group, the highest risks are associated with periodontitis (OR 4.235) and age over 60 yrs. (OR 4.875). For the necrotic pulp tooth group, multivariate analysis identified an age > 60 yrs., filled molars, intracanal posts, poor coronal restoration quality, under-filling, and periodontitis as significant combined risk factors. Inadequate root canal filling and periodontitis in both groups were risk factors associated with most cases of apical periodontitis. Other risk factors include age > 60 yrs., poor coronal restoration quality, and the presence of intracanal posts in root-filled teeth with necrotic pulp.

Endo-periodontal lesions are challenging clinical situations where both the supporting tissues and the root canal of the same tooth are infected. In the present study, chlorhexidine (CHX)-loaded calcium hydroxide (CH) pastes were used as intracanal medications (ICMs). They were prepared and tested on pathogens found in both the root canal and the periodontal pocket. Exposure to 0.5% and 1% CHX-loaded ICMs decreased the growth of Porphyromonas gingivalis and was effective in eradicating or inhibiting an Enterococcus faecalis biofilm. CH was injected into the root canal of extracted human teeth immersed in deionized water. CHX-loaded ICMs resulted in the transradicular diffusion of active components outside the tooth through the apex and the lateral dentinal tubules, as shown by the release of CHX (from 3.99 µg/mL to 51.28 µg/mL) and changes in pH (from 6.63 to 8.18) and calcium concentrations (from 2.42 ppm to 14.67 ppm) after 7 days. The 0.5% CHX-loaded ICM was non-toxic and reduced the release of IL-6 by periodontal cells stimulated by P. gingivalis lipopolysaccharides. Results indicate that the root canal may serve as a reservoir for periodontal drug delivery and that CHX-based ICMs can be an adjuvant for the control of infections and inflammation in endo-periodontal lesions.

Understanding the interaction between endodontic and periodontal lesions is of crucial importance to the clinician because of the challenges commonly encountered in the evaluation, diagnosis, treatment and prognosis of these combined diseases. Among the risk factors for the occurrence and development of endo-periodontal lesions are: incorrect endodontic treatment, lack of coronary seal in coronary restorations, occlusal trauma, radicular resorption of infectious or non-infectious nature, peripheral perforations within the endodontic treatment or dental malformations. The treatment and prognosis of endo-periodontal lesions varies depending on the etiology, pathogenesis and the correct recognition of each specific condition.

To improve the quality and effectiveness of medical care for patients with inflammatory periodontal diseases, it is necessary to search for new approaches in both diagnosis and treatment. The aim of our study is to determine the effect of the diode laser on the pathogenic microflora of periodontal pockets and root canals in patients with endo-periodontal lesions (EPL). We carried out a comparative assessment of the bacterial contents of the root canals and periodontal pockets by polymerase chain reaction (PCR) before and after treatment with a diode laser (Doctor Smile Simpler, wavelength 980 nm) for 54 patients with EPL. The control group consisted of 56 patients who were treated according to the generally accepted method, including professional oral hygiene, endodontic treatment, and curettage of periodontal pockets. Evaluation criteria were a qualitative assessment of the content of periodontopathogens in the root canal and periodontal pocket before and after and treatment. As a result of our study, we found a statistically significant (p