2. table of Content
Endodontic-Periodontic Lesions
Biologic Effects of Periodontal
Infection on the Dental Pulp
Factors Initiating Pulpal
and Apical Diseases
Biologic Effects of
Pulpal Infection on
Periodontal Tissues
Treatment
considerations
0
1
0
3
0
5
07
Classification of Pulpal
and Apical Diseases
0
2
0
4
0
6
08
Differential Diagnosis of Pulpal and
Periodontal Infection (e-only)
Effect of Endodontic Pathosis
on Development of
Retrograde
Peri-Implantitis
3. When inflammation presents on a tooth which
is associated with both pulpal pathology
and the periodontal tissues, it is classed
as a perio-endo lesion.
Endodontic-Periodontic Lesions
4. Sources of communication between the pulp and periodontium.
A: Apical foramen
B: lateral canals
c: Dentinal tubules
D: perforations
e: fractures
f: Developmental Anomalies
5. Sources of communication between the pulp and periodontium:
1. A: Apical foramen the number of apical foramina can vary from tooth to tooth, but each allows
ingress/egress of bacteria.
2. B: lateral canals can involve any part of the root surface including furcation.
3. c: Dentinal tubules the odontoblastic processes can extend from the dentine-pulp complex to
the root surfaces. communication is usually established once root surface cementum is lost.
4. D: perforations these can be in the form of resorption, caries or iatrogenic damage. the extent
and location of the perforation can affect the prognosis for the tooth.
5. e: fractures horizontal fractures are managed depending on where the fracture is located.
Vertical fractures deem the tooth unrestorable.
6. f: Developmental Anomalies e.g. palato-gingival grooves. natural variations in the root surface
which provide areas for bacterial colonization.
6. Lateralcanal
• 59.5% of maxillary 2 premolars possess lateral canals;
78.2% of those canals are located in the apical regions of the root canals.
accessory canals were also found in both midroot and cervical regions, albeit at reduced
frequencies, at 16.2% and 4.0%, respectively.
• A subsequent study showed that 28.4% of permanent molars exhibit patent accessory
canals in furcation regions,
• Root canal therapies frequently fail in maxillary molars because of unidentiied second
mesiobuccally canals. These canals are found in a surprisingly high percentage (80.8%)
of teeth.
• accessory canals can lead to asymptomatic apical periodontitis resulting from chronic
pulpal diseases
8. Advanced pulpitis…
Advanced pulpitis leads to pulp necrosis, which often is accompanied by
inflammatory bone resorption at the root apex, as found in cases of apical
periodontitis or an apical abscess. This is also known as retrograde periodontitis .
13. Classification of Pulpal and Apical Diseases
Pulpal State Symptom Vitality Response to Cold
Normal pulp Asymptomatic Vital Within normal limits
Reversible pulpitis Sensitive to pressure
or temperature
Vital Hypersensitive to cold
Symptomatic irreversible pulpitis Spontaneous
throbbing pain
Vital Hypersensitive to cold
and lingering response
Asymptomatic irreversible pulpitis None Vital Within normal limits
Pulp necrosis Asymptomatic Non Vital No response
Previously treated Variable Non Vital No response
Previously initiated therapy Variable Variable Variable
