Perio Endo Relationships

DEPARTMENT OF PERIODONTICS

PERIO – ENDO RELATIONSHIP

PULPAL DISEASE

• ETIOLOGY -INSTRUMENTATION -PROGRESSION OF DENTAL CARIES -LOCAL TRAUMA

CLASSIFICATION OF PULPITIS

• REVERSIBLE PULPITIS• IRREVERSIBLE PULPITIS• HYPERPLASTIC PULPITIS• PULPAL NECROSIS• Reversible pulpitis = gingivatis• Irreversible pulpitis =periodontitis

EFFECTS ON PERIODONTIUM• PERI RADICULAR LESIONS -ACUTE APICAL PERIODONTITIS -CHRONIC APICAL PERIODONTITIS -CONDENSING OSTEITIS - ACUTE APICAL ABSCESS - CHRONIC APICAL ABSCESS• RETROGRADE PERIODONTITIS

EFFECT OF PERIODONTITIS ON PULP

NO CLEAR CUT EFFECT ON PULP BECAUSE 1. PRESENCE OF INTACT LAYER OF

CEMENTUM2. GOOD CAPACITY FOR DEFENCE AS LONG

AS THE BLOOD SUPPLY THROUGH THE APICAL FORAMANIA IS INTACT

• RETROGRADE PULPITIS

DIFFERENTIATION BETWEEN PERIODONTAL AND PULPAL

LESIONS• SIGNS AND SYMPTOMS OFPERIODONTITIS PULPITIS -POCKET FORMATION -SENSTIVITY TO HOT OR COLD FOODS-ATTACHMENT LOSS - SEVERE PAIN-ON BRUSHING -TENDER ON PERCUSSION-TOOTH MOBILITY -BLEEDING ON PROBING-NO SIGNIFICANT DISCOMFORT TO PERCUSSION OR THERMAL STIMULI

DIFFERENTIATION BETWEEN PULPAL AND PERIODONTAL ABSCESS

PERIODONTAL ABSCESS PULPAL ABSCESS-NO SEVERE PAIN - ACUTE PAIN-SORE OR TENDER -SINUS TRACT AND AREA IN GINGIVA STOMA FORMATION -PUS FORMATION

PATHWAYS OF COMMUNICATION BETWEEN PULP AND PERIODONTIUM

• PATHWAYS OF DEVELOPMENTAL ORIGIN - APICAL FORAMEN - ACESSORY CANALS - DEVELOPMENTAL GROOVES• PATHWAYS OF PATHOLOGICAL ORIGIN - TOOTH FRACTURE - IDOPATHIC RESORPTION - LOSS OF CEMENTUM

• PATHWAYS OF IATROGENIC ORGIN

- EXPOSURE OF DENTINAL TUBULES

-ACCIDENTAL LATERAL PERFORATION DURING ENDODONTIC PROCEDURE

-ROOT FRACTURE DUE TO ENDODONTIC PROCEDURE

ENDO – PERIO LESIONS• MICROBIOLOGY -B.FORSYTHUS -P.GINGIVALIS -T.DENTICOLA -FUSOBACTERIA -SPIROCHETES -WOLINELLA -PEPTO STREPTOCOCCUS

CLASSIFICATION• ACCORDING TO SIMON ET AL -PRIMARY ENDO DONTIC LESION -PRIMARY ENDODONTIC WITH SECONDARY PERIODONTAL LESION -PRIMARY PERIODONTAL LESION -PRIMARY PERIODONTAL LESION WITH SECONDARY ENDODONTIC INVOLEMENT -TRUE COMBINED LESIONS

• ACCORDING TO OLIET AND PALLOCK BASED ON TREATMENT PROCEDURE -LESION THAT REQURIE ENDODONTIC TREATMENT PROCEDURES ONLY-LESION THAT REQUIRE PERIODONTAL TREATMENT PROCEDURES ONLY-LESION THAT REQUIRE COMBINED ENDODONTIC AND PERIODONTIC TREATMENT PROCEDURES• ACCORDING TO WEINE

Primary endodontic lesion• Endodontic problem with fistulization from

the apex and along the root to the gingiva.• Sinus tract can be probed with gutta percha

and silver points.• Diagnosis: -pulp vitality tests negative -dental radiographs• Treatment: - conventional root canal therapy.• Prognosis: excellent

Primary endodontic with secondary periodontal lesion

• Result of long standing primary endodontic lesion draining through periodontal ligament –retrograde periodontitis.

• Diagnosis: -pulpal vitality test negative. -deep periodontal pockets on probing. -dental radiographs• Treatment: -endodontic therapy{rct}. -periodontal therapy{root planning}.• Prognosis: depends on periodontal status

Primary periodontal lesions • Periodontal pocket can be deepen to the

apex.• Diagnosis: -pulp is vital -probing may reach apex of the involved teeth.-dental radiographs• treatment: -periodontal therapy to eliminate the pocket.• Prognosis: depends on periodontal therapy.

Primary periodontal lesion with endodontic involvement

• Periodontal pocket can infect the pulp through a lateral canal which in turn can result in periapical lesion.

• Diagnosis: pulp vitality test can be mixed. pocket formation dental radiographs• Treatment: endodontic and periodontal

therapy.• Prognosis : depends on periodontal therapy.

True combined lesionsResults from the development and

extension of an endodontic lesion in to an existing periodontal lesion.

Periodontitis progress to involve a lateral canal or the apex of the tooth –

retrograde pulpitis.

Pain from the loss of pulpal vitality –most common.

• Diagnosis: -pulp vitality test negative -probing depth up to the apex -dental radiographs• Treatment: -periodontal component is more difficult problem. -treat the endodontic component first because in many cases this will leads to complete resolution of the problem.• Prognosis: depends on the extent and

configuration of attachment loss

Topic is over

Thank you

MANTHRU