Dr.Sapnil MDS Reader

1. PERIO-PULPAL RELATION
Presented by
Dr. Sapnil, MDS
Reader

2. ETIOLOGY
Instrumentation during periodontal
restorative or prosthetic dentistry
Progression of dental caries
Tooth fracture

3. CLASSIFICATION
Reversible pulpitis
Irreversible pulpitis
Hyperplastic pulpitis
Pulpul necrosis

4. ENDO-PERIODONTAL PROBLEMS

5. EFFECTS
OF
PULPAL DISEASE ON PERIODONTIUM
Bone resorption
Radiolucency at the apex of the tooth

6. EFFECT
OF
PERIODONTITIS ON DENTAL PULP
Bacterial and the inflammatory products of periodontitis
gain access to pulp via accessory canals, apical foramina
or dentinal tubules – “RETRO-GRADE PULPITIS”

7. SIGNS AND SYMPTOMS -- PERIODONTITIS
Bleeding on brushing
Bad breath
Tooth mobility
Pocket is tender on probing
Extensive deposits
Suppuration

8. SIGNS AND SYMPTOMS -- PULPITIS
Sensitivity to hot or cold fluids
If extends to periodontal ligament, the affected
tooth can become tender to pressure, biting, or
tapping with
instrument
Necrosis of pulp can result in bony resorption
Pulp death result in radiolucency at the furcation

9. PULPAL AND PERIODONTAL ABSCESSES
PERIODONTAL ABSCESS
Not usually severely painful lesions
May be sensitive to touch, mastication, or
tooth brushing or flossing
APICAL ABSCESS
Commonly communicate directly with the
external soft tissue surface by a sinus tract
through the oral mucosa or gingiva

10. THERAPEUTIC MANAGEMENT
ENDODONTIC LESION PERIODONTAL LESION
Endodontic therapy Flap / drainage

11. COMBINED LESIONS [PERIO – ENDO]
The true combined lesion results from the
development and extension of endodontic lesion
into an existing periodontal lesion
The developing periapical lesion extends
coronally to connect with a pre-existing,chronic,
wide based periodontal pocket

12. If periodontitis progresses to involve a lateral
canal or the apex of a tooth then a secondary
pulpal infection may be induced
Endodontic therapy should precede attempts at
periodontal pocket elimination
After successful endodontics the residual
periodontal pocket that remains can be more
predictably treated