Endo-Periodontal Lesions Without Root Damage: Recommendations for Clinical Management

Background: Endo-periodontal lesions (EPLs) are defined by a pathological connection between the pulp and the periodontium in a specific tooth. Although the identification of EPL etiology is of paramount importance for a correct treatment plan, it may be impossible at times to pinpoint the primary cause prospectively. A critical aspect of treatment planning involves assessing the necessity of root canal treatment in periodontal patients presenting with EPLs, evaluating the indication for periodontal intervention in cases of endodontic origin and determining whether splinting of the affected tooth is required. The aim of this article is to provide a concise perspective on the management of EPLs without root damage. Methods: A clinical decision-making flowchart was created based on current classification systems to guide treatment strategies for EPLs. Results: A flowchart of the treatment of EPLs based on possible decision pathways with a starting point in the diagnosis of the periodontitis or non-periodontitis patient that can prove particularly useful in cases where the initial etiology remains uncertain. Conclusions: EPLs are infections that represent a significant clinical challenge. This article summarizes key diagnostic considerations and therapeutic steps, offering practical guidance for clinicians managing these lesions.