Endo-periodontic Lesions

Question 1

What are main pathways in perio-endo lesions?

Answer 1

o Apical foramen o Lateral and accessory canals o Dentinal tubules

Iatrogenic defects such as vertical root fractures and tooth perforation represent nonanatomic communication between the pulp and periodontium result in the spread of infection from one compartment to the other.

Question 2

What are Classification of endodontic- periodontic lesions?

Answer 2

1. Primary pulpal infection can lead to chronic periradicular periodontitis by which periapical radiolucency can develop and migrate cervically.
2. Primary periodontal infection can lead to extensive breakdown of alveolar crest bone that migrates from the cervical area to the apex.
3. Both primary pulpal infection and primary periodontal infection (independent) endo–perio lesion, exhibiting a characteristic of both.
4. Primary pulpal and primary periodontal infection can occur extensively (combined endo-perio lesion.

Question 3

Talk about Rout of communication between the periodontium and the pulp:

Answer 3

1. The apical foramen is the principal and most direct route of communication between the periodontium and the pulp.
2. Lateral or accessary canals allow pulpal and periodontal communication to exist.
3. Dentinal tubules which contain the odontoblastic process and Passage of microorganisms between the pulp and periodontal tissues is possible through these tubules, when the dentinal tubules are exposed in areas of denuded cementum.

Question 4

What are Factors initiating pulpal and apical disease:

Answer 4

• Microorganism.
• Trauma
• Excessive heat
• Restorative procedures and agents
• Malocclusion

These insults lead to inflammatory change in the pulp:

Reversible or irreversible pulpitis ->Pulpal necrosis ->Periodontium breakdown

Question 5

Talk about The different characteristic of pulpal and periodontal lesion:

Answer 5

Question 6

What are Biologic effect of pulpal infection on periodontal tissue:

Answer 6

Necrotic pulp produces significant inflammatory response. This response can traverse the

• apical foramen
• Furcation
• Lateral canals
• Dentinal tubules
• Areas of trapped necrotic tissue along the surface of the root that extend past the PDL and into the surrounding apical tissue

Question 7

The nature and extend of the periodontal destruction that follows pulpal necrosis depend on the:

Answer 7

• virulence of the pathogens in the root canal system
• the chronicity of the disease
• Defense mechanism of the host

Question 8

Talk about course of infection

Answer 8

• As the degree of pulpal inflammation becomes more extensive, a greater amount of destruction of periodontal tissues ensues.
• Extension of the infection through the PDL space, tooth socket, and surrounding bone occurs, and the pt. begins to experience a localized or diffuse swelling that may result in cellulitis that invades the various facial spaces.
• Most often the infection erupts through the labial or lingual mucosa and results in a draining sinus tract.
• When the path for the infectious process is along the attached gingiva, the infection may dissect the PDL space, resulting in the formation of a deep but narrow periodontal pocket. This pocket usually extends to the main site of infection (root apex) when probed or traced with a guttapercha point.

Question 9

Talk about examination and some treatments of perio-endo

Answer 9

• Narrow probing defect combined with a nonvital pulpal response indicates that the problem is usually of endodontic rather than periodontal origin.
• When endodontic infection is the main cause of the swelling or breakdown of the periodontium, successful endodontic treatment usually results in the healing of both periapical and periodontal tissue.
• At times, trauma to the tooth, sever loss of adjacent periodontal tissues, continued tooth
• mobility, and occlusal trauma prevent
• apical healing.
• In this cases, splinting is sometimes necessary to help stabilize the tooth and allow for potential repair of the apical tissue.

Question 10

What are Biologic effect of periodontal infection on the dental pulp?

Answer 10

1. Avoid using irritating chemicals on the root surface.
2. Minimize the use of ultrasonic scalers when less than 2mm of dentin remains.
3. Allow minor pulpal irritations to subside before completing additional procedures.

Question 11

What’s treatment of perio-endo lesions?

Answer 11

Accurate diagnosis to the source of infection is a critical determinant of treatment outcomes.

• Primary pulpal lesion combined with secondary periodontal defects: Endodontic therapy alone.
• Endodontic-periodontic lesions: endodontic therapy followed by periodontal therapy.

In cases that present with an abscess, the periodontal and periradicular abscess are managed differently.

• The manangement of acute periodontal abscess involves drainage via the periodontal pocket and subgingival scaling and root planning.
• If the swelling is large: flap surgery or incision and drainage.
• The management of acute periradicular abscesses: drained by pulpectomy or incision and drainage.
• When bone loss is too extensive: tooth extraction.
• The use of systemic antibiotics may be indicated when the patient have elevated temperatures, cellulitis , and systemic disease and are immunocompromised.