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Diagnóstico e tratamento de lesões endo-periodontais : revisão narrativa
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Abstract(s)
As lesões endo-periodontais (LEP) constituem uma das condições clínicas mais desafiantes da medicina dentária, devido à sua etiologia multifatorial, à complexidade diagnóstica e à diversidade terapêutica.
Este trabalho apresenta uma revisão narrativa da literatura, estruturada a partir da nova classificação das doenças e condições periodontais e peri-implantares (2018), com o objetivo de sistematizar a evolução das classificações, os mecanismos etiopatogénicos, as manifestações clínicas e os principais protocolos de diagnóstico e tratamento atualmente recomendados.
A análise evidencia a importância da correta distinção entre patologia pulpar e periodontal, uma vez que esta define o plano terapêutico e influencia diretamente o prognóstico do dente. Embora o tratamento endodôntico de qualidade permaneça a base fundamental da abordagem, a integração de terapias periodontais — cirúrgicas e não cirúrgicas — revela-se essencial para a preservação da dentição natural.
As evidências científicas mais recentes apontam para taxas de sucesso encorajadoras quando seguidos protocolos rigorosos e multidisciplinares. Contudo, persistem lacunas no conhecimento, nomeadamente quanto à padronização de técnicas cirúrgicas e critérios prognósticos.
Conclui-se que a gestão eficaz das LEP exige uma prática clínica baseada na evidência, interdisciplinar e centrada no paciente, de modo a garantir abordagens mais previsíveis, acessíveis e bem-sucedidas.
Endo-periodontal lesions (LEP) represent one of the most complex conditions in dentistry, given their multifactorial etiology, diagnostic challenges, and therapeutic diversity. This dissertation provides a narrative review of the literature, structured around the new classification of periodontal and peri-implant diseases and conditions (2018) aiming to systematize the evolution of classifications, etiopathogenic mechanisms, clinical manifestations, and the main diagnostic and therapeutic protocols currently recommended. The analysis highlights the critical importance of accurately distinguishing between pulpal and periodontal pathology, as this distinction guides the therapeutic plan and directly influences tooth prognosis. While high-quality endodontic treatment remains the cornerstone of management, the integration of periodontal therapies — both surgical and non-surgical — is essential to preserve natural dentition. Recent evidence shows encouraging success rates when rigorous and multidisciplinary protocols are followed. Nevertheless, knowledge gaps persist, particularly concerning the standardization of surgical techniques and the definition of prognostic criteria. It is concluded that the effective management of EPL requires evidence-based, interdisciplinary, and patient-centred clinical practice to ensure more predictable, accessible, and successful outcomes.
Endo-periodontal lesions (LEP) represent one of the most complex conditions in dentistry, given their multifactorial etiology, diagnostic challenges, and therapeutic diversity. This dissertation provides a narrative review of the literature, structured around the new classification of periodontal and peri-implant diseases and conditions (2018) aiming to systematize the evolution of classifications, etiopathogenic mechanisms, clinical manifestations, and the main diagnostic and therapeutic protocols currently recommended. The analysis highlights the critical importance of accurately distinguishing between pulpal and periodontal pathology, as this distinction guides the therapeutic plan and directly influences tooth prognosis. While high-quality endodontic treatment remains the cornerstone of management, the integration of periodontal therapies — both surgical and non-surgical — is essential to preserve natural dentition. Recent evidence shows encouraging success rates when rigorous and multidisciplinary protocols are followed. Nevertheless, knowledge gaps persist, particularly concerning the standardization of surgical techniques and the definition of prognostic criteria. It is concluded that the effective management of EPL requires evidence-based, interdisciplinary, and patient-centred clinical practice to ensure more predictable, accessible, and successful outcomes.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Lesões endo-periodontais Diagnóstico diferencial Tratamento endodôntico Tratamento periodontal Prognóstico