Percorrer por autor "Dray, Jonathan Yehouda"
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- Analytical considerations of the endodontic treatments with periodontal impairments: an integrative reviewPublication . Dray, Jonathan Yehouda; Kato, Gabriel FukunagaIntroduction: There is a strong interrelationship between pulpal necrosis and infection on the root canal system with the periodontium, establishing a disease process. Endoperiodontal lesions represent a complex pathological condition arising from the anatomical, microbiological, and inflammatory interrelationship between the dental pulp and periodontal tissues. Natural and acquired communication pathways allow the spread of microorganisms and inflammatory mediators, making diagnosis and treatment challenging and directly affecting prognosis. This integrative review aimed to critically analyze the available scientific evidence on therapeutic approaches and clinical outcomes in the management of endoperiodontal lesions, with particular emphasis on the role of endodontic treatment and its interaction with periodontal therapy. Methodology: An integrative literature review was conducted using the PubMed, Scopus, and Web of Science databases, including studies published up to November 2025. The research question was structured according to the PIOS criteria. Randomized clinical trials, prospective and retrospective studies, longitudinal studies, and case series with a minimum follow-up of six months were included, involving adult patients diagnosed with endodontic–periodontal lesions. Study selection followed PRISMA guidelines, resulting in the inclusion of thirteen studies for qualitative synthesis. Results: The analyzed studies consistently demonstrated that non-surgical endodontic treatment constitutes the biological cornerstone in the management of EPLs and is decisive for periapical healing, regardless of baseline periodontal severity. High periapical healing rates (>80–90%) were reported when adequate (endodontical) chemomechanical debridement and three dimensional root canal obturation were achieved. Periodontal healing outcomes were more variable and strongly influenced by probing depth, clinical attachment loss, and (periapical) lesion classification. In true combined endodontic–periodontal lesions, particularly in patients with periodontitis, adjunctive periodontal regenerative therapies were associated with improved clinical outcomes. Supportive therapies, such as diode laser application, showed additional benefits in periodontal parameters but did not demonstrate a consistent impact (in the outcome). Conclusion: Current evidence indicates that the quality of endodontic treatment is the primary prognostic determinant in the management of endodontic–periodontal lesions, exerting a decisive influence on periapical healing and significantly conditioning periodontal outcomes. A conservative, sequential, and classification-based therapeutic approach—prioritizing high-quality endodontic treatment followed by periodontal reassessment—is essential to optimize clinical outcomes and preserve long-term tooth survival.