Perio-endo lesions - As usual this script includes the slides, sentences that are written inAri al f on t are thing that the Dr said, the rest are the same as the slides Anatomic considerati on There is an intimate relationship between the periodontium and pulpal tissues, as the tooth develops and the root is formed, 3 main ways for communication are created: 1-Apical Foramen: It is the principal and the most direct route, bacterial andinflammatory byproducts may exit/inter from/ to the root canal system , when the abscess is formed from it it's called periapical abscess or peri odontal apical abscess, which results from the infection of the pulp, and later on may result in infection and resorption of the bone, and as you know the bone is considered as a part of the periodontal system. 2-Lateral and Accessory Canals : May be present anywhere along the root, it's present in around 30% of al l teeth, mostly pres ent in the apical third, and maybe also in the Furcation area, lateral accessory canals are mostly present with the l ateral incisor.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
- As usual this script includes the slides, sentences that are written in Arial fon t are thing
that the Dr said, the rest are the same as the slides
Anatomic consideration
There is an intimate relationship between the periodontium and pulpal tissues, as the
tooth develops and the root is formed, 3 main ways for communication are created:
1-Apical Foramen: It is the principal and the most direct route, bacterial and
inflammatory byproducts may exit/inter from/ to the root canal system, when theabscess is formed from it it's called periapical abscess or periodontal apicalabscess, which results from the infection of the pulp, and later on may result in
infection and resorption of the bone, and as you know the bone is considered as apart of the periodontal system.
2-Lateral and Accessory Canals: May be present anywhere along the root, it's
present in around 30% of all teeth, mostly present in the apical third , and maybe alsoin the Furcation area, lateral accessory canals are mostly present with the lateralincisor
2- Perforations: these are either iatrogenic, because of carious lesions, resorption.
3- Vertical root fractures: deep periodontal pocketing and localized destruction
of alveolar bone.
in vertical root fracture and in dental malformation (like grooves) there will be a lineof radiolucency, here after you do RCT and the periodontal treatment you'll find thatstill there is radiolucency, so I may search for vertical root fracture or grooves, cone
beam CT may be useful in detecting them.
Iatrogenic factors: which are caused by a mistake of the Dr. himself, mostly when
the Dr causes a perforation in the canal during RCT, which will result in radiolucency
after the treatment.
Endodontic Disease and the Periodontium
When the pulp becomes inflamed or necrotic, inflammatory byproducts may leach out
through the apex, lateral and accessory canals as well as the dentinal tubules to trigger an inflammatory vascular response in the periodontium.
The effect of periodontal inflammation on the pulp is controversial and conflicting
studies exist, It has been suggested that periodontal disease has no effect on the pulp,at least until it involves the apex, also, It has been reported that pulpal changes
resulting from periodontal disease are more likely to occur when the apical foramen is
involved
Differential Diagnosis of Endo/Perio Lesions
The following classification system was developed by Simon, Glick and Frank in