ENDO_PERIO LESION
INTRODUCTION
The intimate anatomic and vascular connection between the pulp and the periodontium is studied in great detail by the periodontists and the endodontists.(1) These lesions initially present
themselves as just an endodontic lesion and later slowly start showing signs for periodontal involvement. This type of lesion is called by Simon as Class III type of endo-perio lesion.(2) Periodontal involvement is only for establishing as easy route for drainage of endodontic pathology
There are many cases documented about established secondary periodontal and primary endodontic lesions but few of them document the events that took place during the conversion, when diagnosis is most confusing
The Diagnosis
Criteria to establish a Diagnosis
v 1-Pulp vitality
v 2-Probing
v 3-Radiographic finding
v 4-Type of pain
v 5-Sensitivity to Percussion
v 6-Extrusion of Tooth
v 7-swelling
Response to Ice
Pulp:- reduce pain
Periabical:- no response
Periodontal:- normal
Response to Electric pulp test
v Pulp:- low ,normal ,high response
v Periapical:- no response
v Periodontal:- normal
Periodontal Probing
Pulp:- no defects
Periabical:- single defect, may be in unusual site
Periodontal:- numerous defect throughout mouth, sub gingival calculus
Radiographic findings
v Pulp:- shallow caries, recent fillings, occlusal trauma, physical trauma
v Periabical:- deep caries or filling, pulp cap
v Periodontal:- alveolar bone loss, calculus
Type of pain
v Pulp:- sharp, lancinating
v Periapical:- dull, continuous
v Periodontal:- dull or abscent
Sensitivity to Percussion
v Pulp:- normal
v Periabical:- sensitive
v Periodontal:- usually normal
Swelling
v Pulp:- absent
v Periabical:- generlized or localized
v Periodontal:- localized
Differential diagnosis
v For differential diagnostic purposed the “endo-perio lesions” are best classified as endodontic,
v periodontal or combined diseases. They can also be classified by treatment depending on whether endodontic,
v periodontal or combined treatment modalities are necessary
v They include: primary endodontic disease, primary
v periodontal disease and combined diseases. The combined diseases include: primary endodontic disease with
v secondary periodontal involvement, primary periodontal disease with secondary endodontic involvement, and true combined diseases.
PRIMARY ENDODONTIC DISEASE
v An acute exacerbation of a chronic apical lesion on a tooth with a necrotic pulp may drain coronally through
v the periodontal ligament into the gingival sulcus. This condition may mimic clinically the presence of a periodontal
v abscess. In reality, it is a sinus tract from pulpal origin that opens through the periodontal ligament area
v For
v diagnosis purposes, it is imperative for the clinician to insert a gutta-percha cone into the sinus tract and to take
v one or more radiographs to determine the origin of the lesion. When the pocket is probed, it is narrow and lacks
v width.
v similar situation occurs where drainage from the apex of a molar tooth extends coronally into the furcation
v area. This may also occur in the presence of lateral canals extending from a necrotic pulp into the furcation area.
v Primary endodontic diseases usually heal following root canal treatment. The sinus tract extending into
v gingival sulcus or furcation area disappears at an early stage once the necrotic pulp has been removed and the root
v canals are well sealed. It is important to recognize that failure of any periodontal treatment will occur when the
v presence of a necrotic pulp has not been diagnosed, and endodontic treatment has not followed.
v Pre-op: alveolar bone loss + a periapical lesion, a deep narrow pocket was traced on the mesial aspect of the root, the tooth tested vital
COMBINED DISEASES
v Primary endodontic disease with secondary periodontal involvement
v If after a period of time a suppurating primary endodontic disease remains untreated, it may become
v secondarily involved with periodontal breakdown. Plaque forms at the gingival margin of the sinus tract and leads
v to plaque-induced periodontitis in the area.
When plaque or calculus is detected, the treatment and prognosis of
v the tooth are different that those of teeth involved with only primary endododntic disease. The tooth now requires
v both endodontic and periodontal treatments. If the endodontic treatment is adequate, the prognosis depends on
v the severity of the plaque-induced periodontitis and the efficacy of periodontal treatment.
v With endodontic
v treatment alone, only part of the lesion will heal to the level of the secondary periodontal lesion. In general, healing
v of the tissues damaged by suppuration from the pulp space can be anticipated.
v Primary endodontic lesions with secondary periodontal involvement may also occur as a result of root perforation
v during root canal treatment, or where pins or posts have been misplaced during coronal restoration. Symptoms
v may be acute, with periodontal abscess formation associated with pain, swelling, pus or exudates, pocket
v formation, and tooth mobility
v A more chronic response may sometimes occur with out pain, and involves the
v sudden appearance of a pocket with bleeding on probing or exudation of pus. When the root perforation is situated
v close to the alveolar crest, it may be possible to raise a flap and repair the defect with an appropriate filling
v material.
v In deeper perforations, or in the roof of the furcation, immediate repair of the perforation has a better
v prognosis than management of an infected one. Use of mineral trioxide aggregate has resulted in cemental healing
v following immediate repair.
Treatment
Drainage of endodontic lesion through the periodontal ligament:-
v A-pocket usually isolated, deep
v B-& on an unusual tooth surface
v C-root surface feels smooth
v D-fistula may form close to, but not within the gingival crevice
v If lesion organized from priapical region & draining through periodontal ligament space
v Complete endodontic treatment & wait several months to evaluate healing of periodontal lesion
v If lesion is the result of both endodontiec pathology & periodontitis (true endo-peio lesion)
v Evaluate strategic value of the tooth if tx is warranted initiate endodontic therapy first periodontal treatment may be combined with periapcal surgery if needed .prognosis is poorest
المادة المعروضة اعلاه هي مدخل الى المحاضرة المرفوعة بواسطة استاذ(ة) المادة . وقد تبدو لك غير متكاملة . حيث يضع استاذ المادة في بعض الاحيان فقط الجزء الاول من المحاضرة من اجل الاطلاع على ما ستقوم بتحميله لاحقا . في نظام التعليم الالكتروني نوفر هذه الخدمة لكي نبقيك على اطلاع حول محتوى الملف الذي ستقوم بتحميله .