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PULPOPERIODONTAL PROBLEMS (PERIO-ENDO LESION) periodontitis by extension of inflammation from the gingiva into deeper periodontal tissues. periodontitis can also be have entered the periodontal ligament either through the apical foramen

or through the lateral canals. “retrograde periodontitis.”

“retrograde pulpitis” can also occur as a result of periodontal disease and periodontal treatment

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PATHWAYS OF COMMUNICATION BETWEEN PULP AND PERIODONTIUM It can be classified into three categories: 1. PATHWAYS OF DEVELOPMENTAL ORIGIN. • Apical foramen • Accessory canals and lateral canals. • Developmental grooves. • Enamel projections and pearls at the cervical portion. 2. PATHWAYS OF PATHOLOGIC ORIGIN • Tooth fracture (vertical). • Idiopathic resorption can be: a. Internal: From the pulp to the surface of the tooth. b. External: From the external surface of the root to the pulp. • Both internal and external resorption produces communication. • Loss of cementum due to external irritants. 3. PATHWAYS OF IATROGENIC ORIGIN • Exposure of dentinal tubules following root planing. • Accidental lateral perforation during endodontic procedure. • Root fracture due to endodontic procedure.

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POSSIBLE PATHWAYS FOR SPREAD OF INFECTION BETWEEN PULPAL AND PERIODONTAL TISSUES

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CLASSIFICATION OF PERIO-ENDO LESIONS

1. Primary endodontic lesion

2. Primary periodontal lesion

3. Primary endodontic lesion with secondary periodontal involvement

4. Primary periodontal lesion with secondary endodontic involvement

5. True combined lesion

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EFFECTS OF PULPAL DISEASE ON THE PERIODONTIUM The three major causes of pulpal inflammation are: 1. Instrumentation during periodontal, restorative or prosthetic procedures. 2. Progression of dental caries. 3. Tooth fractures.

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MICROBIOLOGICAL FINDINGS B. forsythus, P. gingivalis T. denticola, Fusobacteria, Spirochetes, Wolinella and Peptostreptococcus have been found in endoperio lesions DIAGNOSIS Traditional diagnostic aids including, radiographic analysis with gutta percha tracing, (Fistula Tracking) Periodontal probing, fiberoptic illumination to rule out whether a fracture exists, vitality test, percussion tests

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TREATMENT AND PROGNOSIS OF PERIODONTAL-ENDODONTIC LESIONS