endodontic periodontal interrelation

DR. ADIL IQBALBDS

House SurgeonHamdard Hniversity Hental Hospital

Karachi, Pakistan

Aim OF PRESENTATION:•Discuss relation between endodontic and periodontic diseases.•Biological and clinical evidence of diagnosis•Decision making in the treatment

Dentinal tubules Lateral and accessory canals Apical foramen

minimal inflammatory response………………..extensive destruction.

Sinus tract irrigants ,sealers and ICM may extrude from canal to periodontium..

TWO schools of thaught:•1)no major effect •2)effect is degenerative causing increase in calcification, fibrosis, and direct inflammatory sequlae.•Periodontitis patients are threefold times more prone.•Accessory and lateral canals if present then more chances

Perio lesion

Primary endodontic Primary periodontal Primary endodontic with secondray

periodontal Primary periodontal with secondrary

endodontic True combined

• Deep solitary pocket in absence of periodontal disease

• Drainage thru PDL to gingival sulcus• Diagnosis…radiograph with GP• Radiographically wide PDL space and

periapical radiolucency• Pulp test abnormal or absent• Narrow pocket• Prognosis…usually heal after RCT.

• Clinically chronic marginal periodontitis, plaque accumulation and deposits of plaque and calculus.

• Wider pockets• Bony lesions associated with angular

bone loss extending from cervical lesion towards the apex. Lesion also involves adjacent tooth

• Normal pulp test.• Wider pockets• Prognosis on stage of periodontic diease.

A primary perio lesion wrongly diagnosed and treated as endo lesion. Treatment was failure and tooth lost.

• No treatment of primary endodontic disease for long period of time

• Clear widening of pdl space extending from apical to cervical.

• Pulp test is usually absence of response. • On probing solitary wider pocket extending

toward the apex.• Both endodontic and periodontal

treatments required and prognosis depends on severity of marginal periodontal damage and efficacy of periodontal treatments.

• Chronic marginal periodontitis• Radiographically bone loss from cervical

region towards the apex and usually not limitted to just single tooth.

• Apical radiolucency• Symptoms of pain inflammed pulp at

early stage but later on pulp becomes unresponsive.

• Poor prognosis in single rooted teeth.

Lesion present on both sides May or may not join depending on stage

of disease Extensive radiolucencies of both origin Unresponsive pulp Wider pockets Prognosis is usually guarded. Longitudinal root fractures mimic the

same radiographic picture