Hello Perio, I am an endo problem

What’s Really Going On?

A perio-endo lesion happens when infection or inflammation spreads between the pulp and supporting structures through accessory canals, apical foramina, or dentinal tubules.

 It may start as:

• Primary endodontic — infection begins in the pulp and spreads outward.
• Primary periodontal — disease begins in the periodontium and moves apically.
• True combined — both progress independently until they meet.

Knowing which came first guides everything that follows.

Diagnosis: Don’t Guess — Test

A tooth with a deep pocket or mobility can fool even experienced clinicians.

Use a structured approach:

• Pulp vitality testing (cold or electric).
• Percussion and palpation.
• Probing patterns — narrow vs. broad pockets.
• Radiographic evaluation.
• Cone Beam CT for 3-D clarity

Treatment Sequence: Endo First

Address the pulpal source first.

Perform root canal therapy, allow healing, then reassess:

• If the lesion resolves → primarily endodontic.
• If the defect persists → combined lesion → periodontal therapy follows.

Options include scaling and root planing, regeneration, or surgical correction.

When It’s Not a Perio-Endo Lesion

Occasionally, what looks like a perio-endo problem is actually a vertical root fracture.
These cases often show an isolated deep pocket and localized bone loss that doesn’t respond to treatment. Once confirmed, extraction and implant placement provide the most predictable, long-term result for restoring function and bone stability.

The Takeaway

Perio-endo lesions remind us how interconnected the mouth truly is. A step-by-step diagnosis and the right treatment order can preserve natural teeth — and patient trust.

At Team Perio, we’re always available to collaborate on diagnostic challenges or treatment planning.