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.

1. Endo - Perio Lesions
www.indiandentalacademy.com

2. INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.com

3. DEFINITION
STOCK
Lesion with sub marginal or intra bony peri radicular bone loss of pulpal and/or
periodontal origin that communicates with the oral cavity via probing defect.
An isolated, usually narrow, deep probing depth of pulpal or periodontal origin.
www.indiandentalacademy.com

4. Classification
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
www.indiandentalacademy.com

5. WEINE
Type I - Tooth in which symptoms clinically and radiographically simulate
periodontal
disease but are due to pulpal inflammation
Type II - Tooth that has both pulpal and periodontal disease concomitantly
Type III - Tooth has no pulpal problem but require endodontic therapy plus root amputation to
gain periodontal healing
Type IV - Tooth that clinically and radiographically simulate pulpal or periapical disease but in
fact have periodontal disease
www.indiandentalacademy.com

6. GROSSMAN
GROUP 1- LESIONS REQUIRING ENDODONTIC TREATMENT ONLY
•
Necrotic pulp and apical granulomatous tissue replacing periodontium with or without sinus
tract
•
Chronic peri apical 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 hemi section
•
Root submergence
www.indiandentalacademy.com

7. GROUP 2 - LESIONS REQUIRING PERIODONTAL TREATMENT ONLY
•
Occlusal trauma causing reversible pulpitis
•
Occlusal trauma plus gingival inflammation resulting in pocket formation and reversible
pulpitis
•
Supra bony or infra bony pocket formation treated with overzealous root planning and
curettage leading to pulpal sensitivity
•
Extensive infra bony 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

8. GROUP 3 - 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

9. 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

10. MISCELLANEOUS
Iatrogenic
systemic
SINUS TRACT
INFRABONY POCKET
•From canal
•From gingival crevice
•Narrow
•wide
www.indiandentalacademy.com

11. Causes :( Stock )
Root canal infection
Root fractures – crown / root ( vital / non vital )
www.indiandentalacademy.com
Root perforation

12. Thank you
www.indiandentalacademy.com
Leader in continuing dental education
www.indiandentalacademy.com