Dental lesions can pose a diagnostic challenge in many situations. The dental tissue consists of the endodontium and periodontium. Disease of one tissue may lead to secondary disease in the other as they have embryonic, anatomic and functional interrelationships. The perio-endo lesions have seemingly unclear, overlapping symptoms, inturn making accurate diagnosis difficult. A rationale diagnosis can be arrived at only with clear understanding of various diagnostic modalities. This review, an attempt is made to provide detailed diagnostic modalities for endo-perio dental lesions with emphasis on radiographic diagnostic advancements.