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Endo - Perio lesions
Transcript of Endo - Perio lesions
Periodontal lesions: an inflammatory process in the pulpal tissues resulting from accumulation of dental plaque on the external root surfaces.
True-combined lesions: both an endodontic and periodontal lesion developing independently which meet and merge at a point along the root surface.
Iatrogenic lesions: usually endodontic lesions produced as a result of treatment modalities. Made by: Zuha khan BACKGROUND
The actual relationship between periodontal and pulpal disease was first described by Simring and Goldberg in 1964.
Since then, the term “perio-endo” lesion has been used to describe lesions due to inflammatory products found in varying degrees in both the periodontium and the pulpal tissues. INTRODUCTION
Combined periodontic-endodontic lesions are localized, circumscribed areas of bacterial infection originating from either dental pulp, periodontal tissues surrounding the involved tooth or teeth or both. Perio - Endo lesions Infection from the pulp tissue within a tooth may spread into the bone immediately surrounding the tip or apex of the root, forming a periodical abscess. Such a periodontal lesion is referred to as RETROGRADE PERIODONTITIS3. Pathways of iatrogenic originExposure of dentinal tubules Accidental lateral perforation Root fracture Infection from a periodontal pocket may proliferate via accessory canals into the root canal of the affected tooth, leading to pulpal inflammation. This process has been referred to as RETROGRADE PULPITIS. 2. Pathways of pathologic origin
Tooth fracture (vertical)
Idiopathic resorption can be:
Loss of cementum Pathways of developmental origin PATHWAYS OF COMMUNICATION BETWEEN PULP AND PERIDONTIUM 3. Pathways of iatrogenic origin
Exposure of dentinal tubules
Accidental lateral perforation
Root fracture It can be classified into three categories:
1. Pathways of developmental origin
Accessory canals or lateral canals
Enamel projections and pearls Pulp becomes infected and elicits an inflammatory response of the PDL at the apical foramen and/or adjacent to openings of accessory canals.
An inflammatory exudate, causes local tissue hypoxia resulting in localized necrosis.
Carious lesions of dentine or pulp may ingress bacteria to contaminate an otherwise sterile lesion.
A peri-apical lesion may perforate the cortical bone close to the apex and drain into the gingival sulcus forming pseudo-pockets. 2. PERIODONTAL LESIONS 3. COMBINED LESIONS 4. IATROGENIC LESIONS 1. ENDODONTIC LESIONS Endodontic lesions are further characterized into two sub-categories:Primary endodontic lesions: when a sinus tract has formed to establish drainage Primary endodontic lesions with secondary periodontal involvement: when plaque formation occurring in the sinus tract with progression to periodontitis and associated calculus formation. Presence of plaque and calculus.
Inflammatory mediators cause destruction of gingival connective tissue, PDL and alveolar bone.
Loss of the outer cementoblast layer.
Endotoxins also have an irritant effect on the overlying soft tissue.
Bacterial plaque involving the main apical foramina, compromising the vascular supply.
Damage to the intact cementum layer.
Periodontal pocket bacteria. Periodontal lesions are divided into two sub- categories:
Primary periodontal lesions, when there is a progression of periodontal lesion to involve the apex of a tooth while the pulp is vital (there may be some pulpal degenerative changes).
Primary periodontal lesions with secondary endodontic involvement; periodontal disease causes a resultant pulpal necrosis as it progresses apically. The pathogenesis is similar. Lesions are often indistinguishable from an advanced primary endodontic lesion with secondary periodontal involvement or vice versa. Disease occurs with less frequency. Formed when a coronally progressing endodontic disease joins an infected periodontal pocket progressing apically.The radiographic appearance may be similar to that of a vertically fractured tooth. Include root perforations, overfilling of root canals, coronal leakage, trauma, chemical induced root resorption, intra-canal medicaments and vertical root fractures.
Root perforations that result from extensive carious lesions, resorption or from operator error. BACTERIAS ASSOCIATED WITH PERIODONTITIS DIAGNOSTIC AGENTS
PULP VITALITY TEST
BLOOD FLOW TEST
POCKET PROBING 1. Primary endodontic lesion:
Pulp vitality test is negative.Conventional RCT should be performed, with multiple appointments.
No root planning should be done when the sinus tract is along the PDL, because these fibers are important for reattachment to occur. 2. Primary periodontic lesion:Pulp is vital, probing may reach apex of the involved teeth, with periodontal problems seen on other teeth also.Periodontal therapy to eliminate the pocket. RCT is not usually indicated unless pulp vitality test results change. Periodic re-evaluation is necessary. 3.True combined lesion:Pulp testing is negative. The tooth in question will have probing depths up to the apex of the tooth.Both endodontic and periodontal therapy including root resection and hemi-section. THANK YOU