Non-Cochrane · intervention · PM41274197
Effects of Different Treatment Sequences on the Efficacy of Combined Periodontal-Endodontic Lesions: A Systematic Review and Meta-Analysis.
Fan Yaqian, Sun Fei, Zhu Qiuyan, et al. · International dental journal · 2026 · PubMed · doi:10.1016/j.identj.2025.104021
Findings
Population Adults (18 years or older) with combined periodontal-endodontic lesions
42 findings
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Probing depth (PD) reduction (mm) 4 to 6 months · Clinical (periodontal-endodontic lesions) · Follow-up 4 to 6 months; common-effect model | MD -0.55 [-0.68, -0.43] GRADE not reported 6 studies · 488 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Probing depth (PD) reduction (mm) Clinical (periodontal-endodontic lesions) · Treatment sequence: sequential timing; common-effect model | MD -0.08 [-0.38, 0.21] GRADE not reported 2 studies · 54 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Probing depth (PD) reduction (mm) 7 to 12 months · Clinical (periodontal-endodontic lesions) · Follow-up 7 to 12 months | MD -0.99 [-2.26, 0.27] GRADE not reported 2 studies · 60 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Probing depth (PD) reduction (mm) Clinical (periodontal-endodontic lesions) · Treatment sequence: sequential timing | MD -1.12 [-17.43, 15.19] GRADE not reported 2 studies · 54 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Probing depth (PD) reduction (mm) Clinical (periodontal-endodontic lesions) · Region: other countries | MD -0.58 [-1.23, 0.06] GRADE not reported 6 studies · 331 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Clinical attachment level (CAL) gain (mm) 13 to 18 months · Clinical (periodontal-endodontic lesions) · Follow-up 13 to 18 months; common-effect model | MD 1.31 [1.14, 1.47] GRADE not reported 3 studies · 254 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Probing depth (PD) reduction (mm) Clinical (periodontal-endodontic lesions) · Treatment sequence: sequential basic | MD -1.29 [-1.94, -0.64] GRADE not reported 7 studies · 955 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Clinical attachment level (CAL) gain (mm) 7 to 12 months · Clinical (periodontal-endodontic lesions) · Follow-up 7 to 12 months | MD 0.99 [-0.27, 2.26] GRADE not reported 2 studies · 60 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Probing depth (PD) reduction (mm) 24 months or more · Clinical (periodontal-endodontic lesions) · Follow-up 24 months or more; common-effect model | MD -2.42 [-2.51, -2.34] GRADE not reported 2 studies · 412 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Probing depth (PD) reduction (mm) Clinical (periodontal-endodontic lesions) · Treatment sequence: sequential basic; common-effect model | MD -2.09 [-2.16, -2.02] GRADE not reported 7 studies · 955 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Probing depth (PD) reduction (mm) 13 to 18 months · Clinical (periodontal-endodontic lesions) · Follow-up 13 to 18 months | MD -1.38 [-1.69, -1.08] GRADE not reported 4 studies · 357 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Clinical attachment level (CAL) gain (mm) 4 to 6 months · Clinical (periodontal-endodontic lesions) · Follow-up 4 to 6 months | MD 0.67 [-0.01, 1.34] GRADE not reported 6 studies · 445 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Clinical attachment level (CAL) gain (mm) Clinical (periodontal-endodontic lesions) · Region: other countries; common-effect model | MD 0.47 [0.34, 0.61] GRADE not reported 8 studies · 411 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Probing depth (PD) reduction (mm) Clinical (periodontal-endodontic lesions) · Treatment sequence: simultaneous | MD -0.85 [-7.84, 6.14] GRADE not reported 2 studies · 134 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Probing depth (PD) reduction (mm) Clinical (periodontal-endodontic lesions) | MD -1.07 [-1.49, -0.65] GRADE not reported 15 studies · 1403 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Tooth survival or clinical success rate Clinical (periodontal-endodontic lesions) · common-effect model | RR 1.26 [1.17, 1.36] GRADE not reported 6 studies · 526 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Probing depth (PD) reduction (mm) Clinical (periodontal-endodontic lesions) · Region: China; common-effect model | MD -2.05 [-2.12, -1.98] GRADE not reported 9 studies · 1072 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Clinical attachment level (CAL) gain (mm) Clinical (periodontal-endodontic lesions) · Treatment sequence: sequential timing | MD 1.24 [-15.01, 17.49] GRADE not reported 2 studies · 54 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Probing depth (PD) reduction (mm) Clinical (periodontal-endodontic lesions) · Region: China | MD -1.39 [-1.92, -0.85] GRADE not reported 9 studies · 1072 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Clinical attachment level (CAL) gain (mm) 7 to 12 months · Clinical (periodontal-endodontic lesions) · Follow-up 7 to 12 months; common-effect model | MD 0.99 [0.63, 1.36] GRADE not reported 2 studies · 60 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Probing depth (PD) reduction (mm) 4 to 6 months · Clinical (periodontal-endodontic lesions) · Follow-up 4 to 6 months | MD -0.65 [-1.36, 0.05] GRADE not reported 6 studies · 488 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Probing depth (PD) reduction (mm) Clinical (periodontal-endodontic lesions) · Treatment sequence: sequential advanced; common-effect model | MD -0.57 [-0.75, -0.39] GRADE not reported 4 studies · 260 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Clinical attachment level (CAL) gain (mm) Clinical (periodontal-endodontic lesions) · Region: other countries | MD 0.67 [0.23, 1.11] GRADE not reported 8 studies · 411 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Clinical attachment level (CAL) gain (mm) Clinical (periodontal-endodontic lesions) · Treatment sequence: sequential advanced | MD 0.83 [0.26, 1.41] GRADE not reported 5 studies · 320 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Probing depth (PD) reduction (mm) 24 months or more · Clinical (periodontal-endodontic lesions) · Follow-up 24 months or more | MD -1.90 [-9.27, 5.46] GRADE not reported 2 studies · 412 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Clinical attachment level (CAL) gain (mm) 13 to 18 months · Clinical (periodontal-endodontic lesions) · Follow-up 13 to 18 months | MD 1.31 [0.70, 1.92] GRADE not reported 3 studies · 254 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Probing depth (PD) reduction (mm) Clinical (periodontal-endodontic lesions) · common-effect model | MD -1.73 [-1.79, -1.67] GRADE not reported 15 studies · 1403 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Clinical attachment level (CAL) gain (mm) Clinical (periodontal-endodontic lesions) · Region: China | MD 1.35 [1.13, 1.57] GRADE not reported 5 studies · 420 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Probing depth (PD) reduction (mm) Clinical (periodontal-endodontic lesions) · Treatment sequence: simultaneous; common-effect model | MD -0.92 [-1.13, -0.70] GRADE not reported 2 studies · 134 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Probing depth (PD) reduction (mm) 13 to 18 months · Clinical (periodontal-endodontic lesions) · Follow-up 13 to 18 months; common-effect model | MD -1.38 [-1.54, -1.23] GRADE not reported 4 studies · 357 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Probing depth (PD) reduction (mm) Clinical (periodontal-endodontic lesions) · Treatment sequence: sequential advanced | MD -0.84 [-1.79, 0.11] GRADE not reported 4 studies · 260 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Clinical attachment level (CAL) gain (mm) 4 to 6 months · Clinical (periodontal-endodontic lesions) · Follow-up 4 to 6 months; common-effect model | MD 0.64 [0.51, 0.77] GRADE not reported 6 studies · 445 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Probing depth (PD) reduction (mm) 7 to 12 months · Clinical (periodontal-endodontic lesions) · Follow-up 7 to 12 months; common-effect model | MD -0.99 [-1.36, -0.63] GRADE not reported 2 studies · 60 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Clinical attachment level (CAL) gain (mm) Clinical (periodontal-endodontic lesions) · Treatment sequence: sequential advanced; common-effect model | MD 0.61 [0.45, 0.77] GRADE not reported 5 studies · 320 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Clinical attachment level (CAL) gain (mm) Clinical (periodontal-endodontic lesions) · Treatment sequence: sequential timing; common-effect model | MD 0.20 [-0.09, 0.50] GRADE not reported 2 studies · 54 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Clinical attachment level (CAL) gain (mm) Clinical (periodontal-endodontic lesions) | MD 0.99 [0.61, 1.37] GRADE not reported 13 studies · 831 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Tooth survival or clinical success rate Clinical (periodontal-endodontic lesions) | RR 1.22 [1.08, 1.37] GRADE not reported 6 studies · 526 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Clinical attachment level (CAL) gain (mm) Clinical (periodontal-endodontic lesions) · Treatment sequence: sequential basic; common-effect model | MD 1.33 [1.20, 1.46] GRADE not reported 5 studies · 426 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Probing depth (PD) reduction (mm) Clinical (periodontal-endodontic lesions) · Region: other countries; common-effect model | MD -0.38 [-0.52, -0.24] GRADE not reported 6 studies · 331 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Clinical attachment level (CAL) gain (mm) Clinical (periodontal-endodontic lesions) · Region: China; common-effect model | MD 1.35 [1.22, 1.48] GRADE not reported 5 studies · 420 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Clinical attachment level (CAL) gain (mm) Clinical (periodontal-endodontic lesions) · Treatment sequence: sequential basic | MD 1.33 [1.26, 1.40] GRADE not reported 5 studies · 426 participants |
| Endodontic-first treatment sequence (root canal therapy first or simultaneous, followed by periodontal treatment) | Periodontal-first or periodontal-only treatment | Clinical attachment level (CAL) gain (mm) Clinical (periodontal-endodontic lesions) · common-effect model | MD 0.92 [0.83, 1.01] GRADE not reported 13 studies · 831 participants |
Included primary studies 15
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Ustaoglu 2020 Comparison of GTR, T-PRF and open-flap debridement in the treatment of intrabony defects with endo-perio lesions: a randomized controlled… PMID:31880284 | 2020 | 1 other review | not stated | not extracted yet |
| AlJasser 2021 Regenerative Therapy Modality for Treatment of True Combined Endodontic-Periodontal Lesions: A Randomized Controlled Clinical Trial. PMID:34201328 | 2021 | this review only | not stated | not extracted yet |
| Baochun 2016 [Clinical comparative study on the efficacy of periodontal endodontic therapy and periodontal treatment alone for advanced periodontitis]. PMID:28318161 | 2016 | this review only | not stated | not extracted yet |
| Dong 2023 Time-lapse between periodontal regeneration surgery and root canal therapy in sever combined periodontal-endodontic lesions. PMID:36942208 | 2023 | this review only | not stated | not extracted yet |
| Fang 2021 Efficacy of root canal therapy combined with basic periodontal therapy and its impact on inflammatory responses in patients with combined… PMID:35035760 | 2021 | this review only | not stated | not extracted yet |
| Gui 2014 [Effects of periodontal-pulp combined therapy on severe periodontitis]. PMID:25338798 | 2014 | this review only | not stated | not extracted yet |
| Gupta 2015 Effect of Time Lapse between Endodontic and Periodontal Therapies on the Healing of Concurrent Endodontic-Periodontal Lesions without… PMID:25817213 | 2015 | this review only | not stated | not extracted yet |
| Huang 2022 DOI:10.3969/j.issn.1006-1959.2020.07.036 | NR | this review only | not stated | not extracted yet |
| Li 2021 Comparison of dental pulp periodontal therapy and conventional simple periodontal therapy as treatment modalities for severe periodontitis. PMID:34904079 | 2021 | this review only | not stated | not extracted yet |
| Mediratta 2017 Comparative evaluation of root canal treatment alone and in combination with periodontal flap surgery in the treatment of… DOI:10.4103/jid.jid_37_16 | 2017 | this review only | not stated | not extracted yet |
| Razi 2020 A Comparative Study of Platelet-rich Fibrin (PRF) and Titanium-prepared Platelet-rich Fibrin (T-PRF) in Management of Endo-perio Lesions. PMID:33568585 | 2020 | this review only | not stated | not extracted yet |
| Sharma 2022 Efficacy of Chlorhexidine Intracanal Medicament on Periodontal Healing in Concomitant Endodontic-Periodontal Disease with Communication: A… DOI:10.24018/ejdent.2022.3.2.153 | 2022 | this review only | not stated | not extracted yet |
| Tewari 2018 Effect of immediate periodontal surgical treatment on periodontal healing in combined endodontic-periodontal lesions with communication-A… PMID:29892531 | 2018 | this review only | not stated | not extracted yet |
| Yan 2021 Observation on the effect of periodontal treatment on patients with combined periodontal-pulpal lesions. PMID:34786125 | 2021 | this review only | not stated | not extracted yet |
| Ye 2024 Efficacy and inflammatory responses of root canal therapy plus periodontal non-surgical treatment for periodontal-endodontic combined… PMID:39262760 | 2024 | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
| Review | Shared studies | Jaccard |
|---|---|---|
| Scaffold-Based Biomaterials for Periodontal Regeneration in Periodontitis: A Systematic Review and Meta-Analysis. (2026) | 1 | 0.02 |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adults (18 years or older) with combined periodontal-endodontic lesions | Patients with combined periodontal-endodontic lesions (1468 teeth or patients; n=16) |
| Intervention | Endodontic-first approach (root canal therapy or intracanal medication followed by periodontal treatment) | Endodontic-first treatment (n=16) |
| Comparison | Periodontal-first or periodontal-only treatment | Periodontal-first or periodontal-only treatment (n=16) |
| Outcomes | Probing depth (mm); clinical attachment level or relative attachment level (mm); tooth survival or success rate; secondary: radiographic bone fill, periapical healing, adverse events | PD reduction (n=15); CAL gain (n=13); tooth survival/success (n=6) |
| Study designs | RCTs, non-randomized controlled trials and controlled observational studies; English or Chinese | 10 RCTs and 6 non-randomized studies (n=16) |
| Timing | Not specified | Follow-up 3 to 24 months |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | No | No | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Yes | NRSI: Yes · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: No | NRSI: No · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |