The actual relationship between periodontal and pulpal disease was first described by Simring and Goldberg in The pulp and periodontium have embryonic, anatomic and functional inter-relationships. The simultaneous existence of pulpal problems and inflammatory periodontal disease can complicate diagnosis and treatment planning. A perio-endo lesion can have a varied pathogenesis which ranges from quite simple to relatively complex one. Knowledge of these disease processes is essential in coming to the correct diagnosis. This is achievable by careful history taking, examination and the use of special tests.

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Submit Search. Successfully reported this slideshow. We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime. Endo perio lesions. Upcoming SlideShare. Like this presentation? Why not share! Embed Size px. Start on. Show related SlideShares at end. WordPress Shortcode.

Full Name Comment goes here. Are you sure you want to Yes No. Here's an all-natural gout relief method. Kiruthiga Govindaraju. Sherok Wafek. Sajjad Amin. Show More. No Downloads. Views Total views. Actions Shares. Embeds 0 No embeds. No notes for slide. Endo perio lesions 1. The periodontium includes the gingiva,cementum, periodontal ligament PDL , andalveolar bone. Disease that affects the periodontium usuallyis a result of the direct extension of pulpaldisease or due to apical progression ofperiodontal disease.

When the pulp becomes infected, the diseasecan progress beyond the apical foramen andinflame the PDL. The inflammatory process results inreplacement of the periodontal ligament byinflammatory tissue. Without proper treatment, the inflammatoryresponse can cause resorption of the alveolarbone, cementum, and dentin.

Besides going through the apical foramen,pulpal disease can progress through lateralcanals. Lateral canals are seen mostly in the apicalthird of the root and in the furcation area ofmolars.

Pulp disease may cause an inflammatoryresponse of the PDL at the opening of lateralcanals, resulting in a lateral radiolucency onthe root. The inflammatory response at the lateralcanals may extend crestally along the lateralaspects of the root and ultimately involve thefurcation or crestal area of the attachmentapparatus. The effect of periodontal disease on the pulpis not as clear-cut as the effect of pulpaldisease on the periodontium.

Periodontal inflammation may exert a directeffect on the pulp through the same lateralcanal or apical foramen pathways. The normal pathways of communication between theendodontium and the periodontium 1 -the apicalforamen, 2, 3 - lateral and accessory canals 6.

Pre-operatory image of the samelesion while measuring the initialpocket depth. X-ray image of an endodontic- periodontal lesion caused by an internal root resorbtion. An acute exacerbation of a chronic apicallesion on a tooth with a necrotic pulp maydrain coronally through the periodontalligament into the gingival sulcus.

This condition may mimic, clinically, thepresence of a periodontal abscess. For diagnosis purposes, it is imperative for theclinician to insert a gutta-percha cone into thesinus tract and to take one or moreradiographs to determine the origin of thelesion. When the pocket is probed, it is narrow andlacks width.

Primary endodontic diseases usually healfollowing root canal treatment. The root canal system primarily becomesinfected as a result of dental caries, traumaticinjuries and coronal microleakage. Pulp inflammation or necrosis may lead to aninflammatory response in the periodontalligament at the apical foramen or foramina orat the site of a lateral or accessory canal. Such a lesion may result in a localized ordiffuse swelling that may occasionally involvethe gingival attachment.

Long-term existence of the defect has resultedin deposits of plaque and calculus in thepocket with subsequent advancement of theperiodontal disease. After adequate root canal treatment, lesionsresulting from pulpal necrosis resolve anexceptionally high percentage of the time. The integrity of the periodontium will bereestablished if root canal treatment is donewell. If a draining sinus tract through theperiodontal ligament is present before rootcanal treatment, resolution of the defect thatcan be probed is expected Endodontic-periodontal lesionwith primary endodontic lesions andsecondary periodontal involvement of 16 These lesions are primarily caused by periodontalpathogens.

In this process, chronic periodontitis progresses apicallyalong the root surface. In most cases, pulp tests indicate a clinically normal pulpalreaction.

There is frequently an accumulation of plaque and calculusand the pockets are wider. The prognosis depends on the stage of periodontal diseaseand the efficacy of periodontal treatment.

The pulp may remain vital but may show somedegenerative changes over time. The apical progression of a periodontal pocketmay continue until the apical tissues areinvolved. In this case, the pulp may become necrotic asa result of infection entering via lateral canalsor the apical foramen.

In single-rooted teeth, the prognosis is usuallypoor. In molar teeth, the prognosis may be better. The pulp response to cementum and dentinremoval and exposure of patent dentinaltubules by periodontal root planning will varywith the remaining dentin thickness.

Unless dentin removal is excessive, pulpresponse will be negligible. Although the pulp is exposed to a bacterialchallenge through patent dentinal tubules, itis quite capable of repair and healing.

Production of reparative dentin and reducedcanal diameter may result, but pulp tissueremains relatively unaffected. Primary periodontal lesions withsecondary endodonticinvolvement lesion These lesions occur when an endodonticallyinduced periapical lesion exists at a tooth that isalso affected by marginal periodontitis. The tooth has a pulpless, infected root canalsystem and a co-existing periodontal defect. This is particularly true in single-rooted teeth.

Inmolar teeth, root resection can be considered asa treatment alternative if not all roots areseverely involved Endodontic and periodontaldiseases are occurringindependently of each other. Endodontic disease is occurringsecondarily to a periodontalcondition due to bacterialretrograde from distal root Periodontal disease at thefurcation is occurring secondarilyto a pinpoint perforation at thefurcation floor.

Pulpal necrosis subsequent toperiodontal treatment andsignificant osseous loss. No otheraetiology could be shown. The major connections between periodontaland pulpal tissues are the apical foramina. In addition to the apical foramina andaccessory canals, there is a third possibleroute for bacteria and their products, thedentinal tubules.

They are serious complications during dental treatment and have arather poor prognosis. Perforations may be produced by powered rotary instruments during theattempt to gain access to the pulp or during preparation for a post. Improper manipulation of endodontic instruments can also lead to aperforation of the root. The second group of artificial pathways betweenperiodontal and pulpal tissues are vertical rootfractures.

Vertical root fractures are caused by trauma andhave been reported to occur in both vital andnon-vital teeth. In vital teeth, vertical fractures can becontinuations of coronal fractures in the"cracked tooth syndrome," or can occur solelyon root surfaces. In general, when primary disease of one tissue, i. When secondary disease is established and chronic,both primary and secondary diseases must betreated.

By and large, endodontic therapy precedesperiodontal therapy. Periodontal therapy may or may not be required,depending on disease status. The complete healing of destroyed periodontalsupport can be expected following the treatment ofpulpal pathology. It is important to realize that it is clinically notpossible to determine the extent to which one or theother of the two disorders endodontic orperiodontal has affected the supporting tissues.

Therefore, the treatment strategy must be first tofocus on the pulpal infection and to performdebridement and disinfection of the root canalsystem. The second phase includes a period ofobservation, whereby the extent of periodontalhealing resulting from the endodontic treatmentis followed.

Reduced probing depth can usually be expectedwithin a couple of weeks while bone regenerationmay require several months before it can beradiographically detected.


Endo-Perio Dilemma: A Brief Review

Correspondence Address : Dr. Diagnosis and management of endo-perio lesions differ from those lesions of single causative factor. These present signs and symptoms, which cannot be easily attributed or accounted for, require more detailed examination and definitive treatment plan. The outcomes are not readily predictable as of lesions of single origin.


A New Classification of Endodontic-Periodontal Lesions

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Combined periodontic-endodontic lesions

Box , Riyadh , Saudi Arabia. The interrelationship between periodontal and endodontic disease has always aroused confusion, queries, and controversy. Differentiating between a periodontal and an endodontic problem can be difficult. The nature of that pain is often the first clue in determining the etiology of such a problem. Radiographic and clinical evaluation can help clarify the nature of the problem.

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