REFINING THE TREATMENT OF LOCALIZED PERIODONTITIS USING MODERN ENDODONTIC INSTRUMENTS: AN INTEGRATED ENDO-PERIO APPROACH

Localized periodontitis represents a prevalent and clinically challenging form of periodontal disease characterized by site-specific attachment loss, periodontal pocket formation, and alveolar bone destruction confined to one or a few teeth. The intimate anatomical and pathological relationship between the pulp and periodontium, mediated through dentinal tubules, lateral canals, and the apical foramen, creates a bidirectional pathway for the spread of infection and inflammation between the endodontic and periodontal compartments. This endo-perio interconnection necessitates an integrated diagnostic and therapeutic approach that transcends the traditional boundaries between endodontic and periodontal specialties. While conventional periodontal therapy comprising scaling and root planing, surgical pocket elimination, and regenerative procedures addresses the periodontal component, the endodontic dimension of localized periodontitis frequently remains underdiagnosed and undertreated. This article provides a comprehensive analysis of the endo-perio interface in localized periodontitis, critically evaluates the diagnostic challenges in distinguishing primary endodontic, primary periodontal, and combined lesions, and proposes a refined, technology-enhanced treatment protocol. By integrating modern endodontic instruments including nickel-titanium rotary files, ultrasonic activation, cone-beam computed tomography (CBCT) imaging, and advanced irrigation delivery systems, this review synthesizes evidence from endodontic and periodontal literature to advocate for a minimally invasive, biologically driven approach. The goal is to achieve comprehensive disinfection of the root canal system, eliminate the endodontic contribution to periodontal pathology, and promote true periodontal regeneration.