Oral Biological and Periodontal Inflammatory Responses Following Endodontic Treatment of Endo-Perio Lesions

Abstract

Background: Endodontic-periodontal lesions are complex lesions that involve a combination of pulpal infection and periodontal inflammation. Pathological and anatomical connections between the pulp and periodontal tissues make it possible that a pulp infection could help to maintain periodontal tissue destruction and continuing inflammation. A comprehensive assessment of healing after endodontic therapy may be achieved by the evaluation of both clinical parameters and inflammatory markers.

Objective: To evaluate oral biological and periodontal inflammatory responses following endodontic treatment of endo-perio lesions.

Methods: This prospective clinical study included 75 patients with confirmed endodontic-periodontal lesions and was conducted from January 2025 to June 2025 at Women Dental College, Abbottabad. The parameters evaluated at baseline, 3 months and 6 months included probing pocket depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), gingival index (GI) and plaque index (PI). Interleukin-1 beta (IL-1β), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) levels were measured in gingival crevicular fluid samples. Radiographic healing was also assessed as was clinical symptoms. Appropriate statistical tests, repeated measures and comparative were used to analyze data and a p value of < 0.05 was deemed to be statistically significant.

Results: Mean PPD decreased from 6.18 ± 1.27 mm at baseline to 3.29 ± 0.89 mm at six months, while mean CAL improved from 6.74 ± 1.42 mm to 3.91 ± 1.02 mm (p < 0.001). BOP declined from 72.4 ± 18.6% to 25.8 ± 13.9%, accompanied by significant improvement in GI and PI. Mean IL-1β decreased from 86.3 ± 22.7 to 43.5 ± 14.9 pg/mL, IL-6 from 41.7 ± 12.6 to 19.6 ± 7.7 pg/mL, and TNF-α from 32.8 ± 9.7 to 16.4 ± 6.2 pg/mL at six months (all p < 0.001). Overall treatment success was observed in 64 (85.3%) patients. Greater reductions in inflammatory biomarkers were associated with more pronounced periodontal improvement.

Conclusion: Endodontic treatment of endo-perio lesions was associated with significant improvement in periodontal health, reduction in local inflammatory cytokines, symptom resolution, and favorable radiographic healing. Monitoring IL-1β, IL-6, and TNF-α alongside conventional periodontal parameters may provide additional insight into biological healing following treatment.