Management of Periodontal Abscesses and Endodontic-Periodontal Lesions-A Systematic Review

To evaluate the management of periodontal abscesses and endodontic-periodontal lesions (EPLs).

Seven focused questions addressed outcomes such as pocket depth (PD), bleeding on probing (BOP), tooth loss or ovoid elevation. The literature search covered three electronic databases and manual sources for intervention studies. Meta-analyses were not feasible.

For periodontal abscesses and EPLs, a total of 987 and 545 articles were identified, and 17 and 44 were selected for full-text analysis, respectively. For periodontal abscesses, three randomised clinical trials (RCTs) and two prospective case series were included, and it was shown that combined approaches led to reductions in PD of 2-3 mm, BOP from 100% to 30%-44% and ovoid elevation from 92%-100% to 0%-11%. Abscess recurrence was found in 13.3%-23% within 15 months follow-up. For EPLs, nine RCTs, six prospective and two retrospective studies and one case series were included, and the overall synthesis showed that PD reductions ranged from 2.5 to 9.3 mm and tooth loss rate from 0% to 25% (3-120 months follow-up). Low to high risk of bias was evident.

Periodontal abscesses can effectively be managed by initial drainage, followed by periodontal therapy, based on limited and weak evidence. For EPLs, endodontic and periodontal (non-surgical and surgical) interventions have been investigated, alone or in combination, but the heterogeneity of study designs and small sample sizes preclude strong conclusions.