Endo Perio Lesions

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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