Endo perio lesions /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

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Endo perio lesions /certified fixed orthodontic courses by Indian dental academy

  1. 1. www.indiandentalacademy.com
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3. CONTENTS                 INTRODUCTION DEFINITION CLASSIFICATION ETIOLOGY CONTROVERSIES REGARDING THE COMBINED LESION PATHWAYS OF SPREAD COMPARISION OF CLINICAL PRESENTATION B/W APICAL & MARGINAL PERIODONTITIS DIFFERENTIAL DIAGNOSIS EFFECT OF PULP & ITS TREATMENT ON PERIODONTIUM EFFECT OF PERIO. DISEASE & TREATMENT ON PULP PERIODONTAL EVALUATION LESIONS DIAGNOSIS TREATMENT REFERENCES CONCLUSION www.indiandentalacademy.com
  4. 4. DEFINITION •An isolated, usually narrow, deep probing depth of pulpal or periodontal origin. •Lesion with sub marginal or intrabony periradicular bone loss of pulpal and/or periodontal origin that communicates with the oral cavity via probing defect. •A localized periodontal probing depth of pulpal or periodontal origin. www.indiandentalacademy.com STOCK
  5. 5. COHEN • Primary endodontic lesion • Primary endodontic lesion with secondary periodontal involvement • Primary periodontal lesion • Primary periodontal lesion with secondary endodontic involvement • True combined lesion • Concomitant pulpal & periodontal lesion DIA PG 654 www.indiandentalacademy.com
  6. 6. WEINE  Tooth in which symptoms clinically and radiographically simulate periodontal disease but are due to pulpal inflammation  Tooth that has both pulpal and periodontal disease concomitantly  Tooth has no pulpal problem but require endodontic therapy plus root amputation to gain periodontal healing  Tooth that clinically and radiographically simulated pulpal or periapical disease but infact has periodontal disease www.indiandentalacademy.com
  7. 7. LESIONS REQUIRING ENDODONTIC TREATMENT ONLY  necrotic pulp and apical granulomatous tissue replacing periodontium with or without sinous tract  Chronic periapical abscess with sinus tract  Longitudinal and horizontal root fractures  Pathologic and iatrogenic root perforations  Teeth with incomplete apical root development  Endodontic implants  Teeth that require hemisection  Root submergence GROSSMAN www.indiandentalacademy.com
  8. 8. LESIONS REQUIRING PERIODONTAL TREATMENT ONLY  Occlusal trauma causing reversible pulpitis  Occlusal trauma plus gingival inflammation resulting in pocket formation and reversible pulpitis  Suprabony or infrabony pocket formation treated with overzealous root planning and curettage leading to pulpal sensitivity  Extensive infrabony pocket formation extending beyond the root apex and sometimes coupled with lateral or apical resorption yet with pulp that responds with in normal limits to clinical testing www.indiandentalacademy.com
  9. 9. LESIONS REQUIRING COMBINED ENDO – PERIO TREATMENT  Any lesion in Group I That results in irreversible reactions in the attachment apparatus and requires periodontal treatment  Any lesion in Group II that results in irreversible reactions to the pulp tissue and also requires endodontic treatment www.indiandentalacademy.com
  10. 10. ATYPICAL ANATOMIC FACTORS Malaligned tooth Multirooted teeth / additional root Additional canal Cervical enamel projection Large lateral / accessory canal TRAUMA With gingival inflammation Tooth fracture Pulp / perio involvement + sinus tract Cellular changes - resorption www.indiandentalacademy.com
  11. 11. MISCELLANEOUS Iatrogenic systemic SINUS TRACT INFRABONY POCKET •From canal •From gingival crevice •Narrow •wide www.indiandentalacademy.com
  12. 12. CONTROVERSIAL ASPECT CONCERNING THE COMBINED LESION  PULPAL  PERIODONTAL Chacker Massler Czarnecki & Schilder PERIODONTAL PULPAL ? Venous blood flow outward Drawback Lateral / accesory canal - flow bothways Seltzer & bender Stahl www.indiandentalacademy.com
  13. 13. Physiologic : • Apical foramen • Lateral canals • Dentinal tubules • Periodontal ligament • Alveolar bone • Neural pathways • Vasculolymphatic pathway Iatrogenic : • Palatogingival grooves • Cementum defect • Vertical root fractures • Perforations www.indiandentalacademy.com
  14. 14. COMPARISION MARGINAL PERIODONTITIS APICAL PERIODONTITIS Cervical Apex Plaque Pulpal inflammation Horizontal / Vertical bone loss - Seldom bone loss – localized generalized & deep Open Contained www.indiandentalacademy.com
  15. 15. Attachment loss asso. with  Anatomic defect on root  Nature of pathogenic flora  Necrotic & infected pulp  Host defense mechanism defect. Aggresiveness asso with  Lateral & apical foramen  Nature of flora  Apical host defense Periodontal probing & radiographic examination Radiographic examination www.indiandentalacademy.com
  16. 16. DIFFERENTIAL DIAGNOSIS PULPAL PERIODONTAL Cause pulp infection periodontal Vitality non vital vital Restorative deep or extensive not related Plaque /calculus not related primary cause Inflammation acute chronic Pockets single and narrow multiple and wide pH value acidic alkaline Trauma primary or secondary contributing factor Microbial few CLINICAL coronally www.indiandentalacademy.com complex
  17. 17. RADIOGRAPHIC Pattern Bone loss Periapical Vertical bone loss: localized wider apically radiolucent no generalized wider coronally not related yes HISTOPATHOLOGY Junctional epithelium Granulation tissues Gingival no apical migration apical (minimal) normal present coronal (larger) recession TREATMENT Therapy RCT www.indiandentalacademy.com Periodontal therapy
  18. 18. Problems in diagnosis : Vertical root fracture: varied radiographic picture Different angulations Surgical exposure lateral condensation excessive Post placement Cause Extensive restorations Older patients Gingival sulcus & pocket area Single rooted teeth multirooted teeth Developmental grooves In doubt ? – Biopsy / Histological analysis Systemic diseases mimic lesion on radiograph : Scleroderma Metastatic carcinoma Osteosarcoma www.indiandentalacademy.com
  19. 19. EFFECT OF PULP AND ITS TREATMENT ON PERIODONTIUM Periodontal inflammation & bone loss Sub marginal bone loss Horizontal bone loss Vertical intrabony pockets Furcation involvement Periodontal wound healing Traumatized necrotic pulp RC infection – compromised healing Gingival tissue thickness Alveolar bone level Surgical trauma to flap Effective flap repositioning Root canal treatment Doubtful pulpal status Iatrogenic problems www.indiandentalacademy.com
  20. 20. EFFECT OF PERIODONTAL DISEASE & ITS TREATMENT ON PULP Periodontal disease & pulp •Limited •Channels closed + dystrophic calcification- chronic •Sufficient viurlence – pulpal disease •Poor prognosis •Extraction / Root resection Periodontal treatment & pulp •Scaling & root planing – excessive cementum removal •Compromised pulp www.indiandentalacademy.com
  21. 21. Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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