Join us for another installment of our FREE COD Webinar Series:
“Is the Tooth Really Fractured? Diagnosis and Management of J-Shaped, Large Periapical Lesions and Persistent Disease”
This lecture will be presented on March 11, 2026, at 7pm -9pm central with Dr. Jorge Vera presenting. Registration is free for all COD members that are current with their 2025/2026 dues.
REGISTER HERE
*Zoom link to webinar will be emailed on Wednesday, March 11 to all registered.
Course Description:
In certain clinical situations, peri-radicular lesions of endodontic origin can be difficult to distinguish from lesions caused by periodontal disease. When a sinus tract originating from an endodontic lesion drains along the periodontal ligament, the radiographic and clinical presentation may closely resemble a periodontal pocket.
Cone beam computed tomography (CBCT) may reveal extensive peri-radicular bone destruction. However, it does not provide definitive information regarding remaining soft tissue attachment. Therefore, accurate diagnosis requires integration of clinical findings, radiographic interpretation, pulp testing, periodontal evaluation, and adjunctive imaging.
This lecture will review the biological mechanisms of bone lesion formation secondary to pulpal disease, including pathways of extension into the oral cavity. Emphasis will be placed on diagnostic decision-making and clinical management of endodontic–periodontal lesions, with special focus on:
- J-shaped radiolucencies
- Large periapical lesions
- Cracked and potentially fractured teeth
- Differentiating lesions of endodontic versus periodontal origin
- Persistent disease
Healing expectations and current controversies will also be discussed, including when healing should be anticipated and when persistent pathology suggests alternative diagnoses or treatment approaches.
Learning Objectives
At the conclusion of this lecture, attendees will be able to:
- Understand the diagnosis, treatment options, and prognosis of apical periodontitis when it mimics periodontal disease.
- Recognize the causes of non-healing endodontic lesions that present with periodontal characteristics.
- Differentiate between endodontic and periodontal lesions, including lesions associated with cracked and fractured teeth.
- Formulate evidence-based treatment strategies for “J-shaped” radiolucencies and large periapical lesions.
- Examine studies addressing factors that may contribute to the lack of healing in these cases.
