Kazan medical journalKazan medical journal0368-48142587-9359Eco-Vector888310.17816/KMJ2018-362Research ArticleFeatures of clinical course and treatment principles of endodontic-periodontal lesionsMorozP Idemidova-66@yandex.ruIordanishviliA Kdemidova-66@yandex.ruProhodnayaV Ademidova-66@yandex.ruMaxyukovS Yudemidova-66@yandex.ruSafronenkoA Vdemidova-66@yandex.ruGulyaevaE Shdemidova-66@yandex.ruRostov State Medical UniversityMilitary Medical Academy named after S.M. KirovVolgograd State Medical University1506201899336236828052018Copyright © 2018, Moroz P.I., Iordanishvili A.K., Prohodnaya V.A., Maxyukov S.Y., Safronenko A.V., Gulyaeva E.S.2018<p><strong>Aim.</strong> To study the characteristic differences in the clinical course of chronic generalized periodontitis in the presence of periapical infection focus and the principles of combined treatment of endodontium and periodontium.</p>
<p><strong>Methods.</strong> A clinical and X-ray examination of 1525 patients of different age groups was performed. As a result, a clinical group of 68 patients with chronic generalized moderate and severe periodontitis was formed, who were divided into two groups depending on the presence or absence of periapical destruction. In group 1, 32 patients with the presence of chronic generalized periodontitis and signs of chronic apical periodontitis were united. Group 2 included 36 patients with chronic generalized periodontitis and no periapical infection and damage. The index estimation of the periodontal tissues state in the dynamics of combined endodontic and periodontal treatment was performed.</p>
<p><strong>Results.</strong> The initial task of treating endodontic periodontal lesions, regardless of the localization of the primary lesion focus, is the elimination or reversal of chronic periapical inflammatory processes of the teeth. The proposed monitoring system in the course of treatment and dynamic follow-up for 18 months for patients suffering from endodontic periodontal lesions using clinical and radiological methods of examination involves: (1) interim epicrisis or conclusion about negative or positive compliance 1-2 months after the completion of endodontic treatment and hygiene procedures; (2) periodontal treatment (according to indications) with the assessment of clinical efficacy 6 and 12 months after the start of treatment; (3) epicrisis after 18 months.</p>
<p><strong>Conclusion.</strong> The use of proposed concept of complex treatment of endodontic-periodontal lesions, monitoring system in the course of dental therapeutic and preventive measures and dynamic follow-up for 18 months allows achieving positive compliance in 85% of patients according to the clinical examination and in 80% of patients according to radiologic examination.</p>endodontic-periodontal lesionsendodontiumperiodontiumchronic generalized periodontitiscombined treatmentэндодонто-пародонтальные пораженияэндодонтпародонтхронический генерализованный пародонтиткомбинированное лечение[Mukhamedzhanova L.R. Assessment of the prevalence and structure of endoperiodontal lesions: the importance for clinical practice. Klinicheskaja stomatologija. 2011; (2): 99–101. (In Russ.)][Turner J.H., Drew A.H. Experimental injury into bacteriology of pyorrhea. Proc. R. Soc. Med. (Odontol.). 1919; 12: 104.][Simring M., Goldberg M. The pulpal pocket approach: retrograde periodontitis. J. Periodontol. 1964; 35: 22. DOI: 10.1902/jop.1964.35.1.22.][Grudyanov A.I., Moskalev K.E., Makeeva M.K., Byakova S.F. Endodontic-periodontal lesions. Principles of diagnosis and treatment. Endodontiya. 2010; (1–2): 37–41. (In Russ.)][Moroz P.V., Gadzhiev N.M., Kononenko S.L. Endodontic treatment in complex therapy of periodontitis. Glavnyy vrach Yuga Rossii. 2013; (3): 23. (In Russ.)][Peeran S.W., Thiruneervannan M., Abdalla K.A., Mugrabi M.H. Endo-perio lesions. Intern. J. Sci. Technol. Res. 2013; 5 (2): 268–274.][Galeeva Z.R. Morphofunctional and etiopathogenetic connections in endodontic and periodontal pathology. Endodontiya today. 2012; (2): 3–7. (In Russ.)][Galeeva Z.R., Mukhamedzhanova L.R., Gruber N.M. Tubular pathway of microbial invasion in patients with endoperiodontal foci of infection. Prakticheskaya meditsina. 2012; (8): 31–34. (In Russ.)][Vitkov L., Krautgartner W.D., Hannig M. Bacterial internalization in periodontitis. Oral Microbiol. Immunol. 2005; 20: 317–321. DOI: 10.1111/j.1399-302X.2005.00233.x.][Rot F. Treatment of extensive combined lesions of pulp and periodontium. Dental IQ. 2011; 30: 83–91. (In Russ.)][Al-Fouzan K.S. A new classification of endodontic-periodontal lesions. Intern. J. Dentistry. 2014; 2014: 919173. DOI: 10.1155/2014/919173.][Clauder T. The endo-perio lesion: A challenge for the endodontic practice. Endo. Tribune U.S. 2007; 3: 14–15.][Dani N.H., Saquib S.A. Periodontal management of non healing endodontic lesion. IJDA. 2011; 1 (3): 433–437.][Moroz P.V., Orekhova L.Yu., Lomova A.S. Distinctive features of periodontal status of patients with endoparodontal syndrome. Periodontologiya. 2015; (4): 53–58. (In Russ.)][Moroz P.V., Prokhodnaya V.A., Lomova A.S. Dynamics features pаrodontal disease in patients with еndopardontal pockets of infection in the combined treatment. Meditsinskiy vestnik Yuga Rossii. 2014; (1): 75–79. (In Russ.)][Omel'chenko V.P., Demidova A.A. Medicinskaya informatika. Rukovodstvo k prakticheskim zanyatiyam. Uchebnoe posobie. (Medical Informatics. A study guide: a tutorial.) Moscow: GEOTAR-Media. 2017; 324–356. (In Russ.)]