This document provides an overview of endodontic-periodontal interactions. It discusses the pathways connecting endodontic and periodontal tissues, the etiology of endo-perio lesions, classifications of endo-perio lesions, diagnostic procedures, differences between periodontal and periapical abscesses, the endo-perio controversy, and management of pulpal and periodontal diseases. The key relationships covered are the anatomical and pathological connections between the pulp and periodontium, the bacteria commonly found in both tissues, and the debate around whether periodontal or endodontic disease can cause the other.
mucogingival surgery or plastic surgery of muco-gingival tissue is a surgical procedure targeted to correct and eliminate anatomic, developmental and traumatic alterations of gingiva.
mucogingival surgery or plastic surgery of muco-gingival tissue is a surgical procedure targeted to correct and eliminate anatomic, developmental and traumatic alterations of gingiva.
Furcation involvement is a common sequela of severe chronic periodontal disease. Its effective management has a profound influence on the outcome of periodontal therapy.
The periodontium and pulp are two most important entities of the tooth, infection from one can travel towards other by different pathways. Neglect of either one can lead to failure. This presentation will help you learn clear steps towards diagnosis and treatment planning of such lesions
Periodontitis is a complex infection initiated by bacteria –tissue destruction.
Host: the organism from which a parasite obtains its nourishment/ an individual who receives a graft
Modulation: the alteration of function or status of something in response to a stimulus or an altered physical or chemical environment
INTRODUCTION
DEFINITION
TYPES OF TRAUMA FROM OCCLUSION
GLICKMAN CONCEPT
WAERHAUG CONCEPT
STAGES OF TISSUE RESPONSE TO INJURY
CLINICAL AND RADIOGRAPHIC FEATURES OF TFO
CLINICAL DIAGNOSIS OF TFO
TFO AND IMPLANTS
TREATMENT OF TFO
CONCLUSION
REFRENCES
A simple presentation to guide a dentist to choose best irrigant for the case. types of irrigants, their properties, advantages and disadvantages and tips has been discussed through this presentation.
Endo perio lesions /certified fixed orthodontic courses by Indian dental aca...Indian dental academy
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.
Furcation involvement is a common sequela of severe chronic periodontal disease. Its effective management has a profound influence on the outcome of periodontal therapy.
The periodontium and pulp are two most important entities of the tooth, infection from one can travel towards other by different pathways. Neglect of either one can lead to failure. This presentation will help you learn clear steps towards diagnosis and treatment planning of such lesions
Periodontitis is a complex infection initiated by bacteria –tissue destruction.
Host: the organism from which a parasite obtains its nourishment/ an individual who receives a graft
Modulation: the alteration of function or status of something in response to a stimulus or an altered physical or chemical environment
INTRODUCTION
DEFINITION
TYPES OF TRAUMA FROM OCCLUSION
GLICKMAN CONCEPT
WAERHAUG CONCEPT
STAGES OF TISSUE RESPONSE TO INJURY
CLINICAL AND RADIOGRAPHIC FEATURES OF TFO
CLINICAL DIAGNOSIS OF TFO
TFO AND IMPLANTS
TREATMENT OF TFO
CONCLUSION
REFRENCES
A simple presentation to guide a dentist to choose best irrigant for the case. types of irrigants, their properties, advantages and disadvantages and tips has been discussed through this presentation.
Endo perio lesions /certified fixed orthodontic courses by Indian dental aca...Indian dental academy
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.
Endodontic periodontic lesions / rotary endodontic courses by indian dental...Indian dental academy
Welcome to Indian Dental Academy
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.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
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In this brief lecture I will discuss most common endodontic emergencies that occur while practicing endodontics. The lecture is directed to the mind of undergraduate level.
I hope you enjoy it.
This brief lecture talk about very important topic in endodontic diagnosis and it is the Endodontic-Periodontal Relationship. It's directed to the level of mind of undergraduate students. I tried to keep it as simple and coherent as possible
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.
Endo perio interrelation 1 /certified fixed orthodontic courses by Indian den...Indian dental academy
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.
Endo perio lesions /certified fixed orthodontic courses by Indian dental acad...Indian dental academy
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.
DERIVATION OF MODIFIED BERNOULLI EQUATION WITH VISCOUS EFFECTS AND TERMINAL V...Wasswaderrick3
In this book, we use conservation of energy techniques on a fluid element to derive the Modified Bernoulli equation of flow with viscous or friction effects. We derive the general equation of flow/ velocity and then from this we derive the Pouiselle flow equation, the transition flow equation and the turbulent flow equation. In the situations where there are no viscous effects , the equation reduces to the Bernoulli equation. From experimental results, we are able to include other terms in the Bernoulli equation. We also look at cases where pressure gradients exist. We use the Modified Bernoulli equation to derive equations of flow rate for pipes of different cross sectional areas connected together. We also extend our techniques of energy conservation to a sphere falling in a viscous medium under the effect of gravity. We demonstrate Stokes equation of terminal velocity and turbulent flow equation. We look at a way of calculating the time taken for a body to fall in a viscous medium. We also look at the general equation of terminal velocity.
Observation of Io’s Resurfacing via Plume Deposition Using Ground-based Adapt...Sérgio Sacani
Since volcanic activity was first discovered on Io from Voyager images in 1979, changes
on Io’s surface have been monitored from both spacecraft and ground-based telescopes.
Here, we present the highest spatial resolution images of Io ever obtained from a groundbased telescope. These images, acquired by the SHARK-VIS instrument on the Large
Binocular Telescope, show evidence of a major resurfacing event on Io’s trailing hemisphere. When compared to the most recent spacecraft images, the SHARK-VIS images
show that a plume deposit from a powerful eruption at Pillan Patera has covered part
of the long-lived Pele plume deposit. Although this type of resurfacing event may be common on Io, few have been detected due to the rarity of spacecraft visits and the previously low spatial resolution available from Earth-based telescopes. The SHARK-VIS instrument ushers in a new era of high resolution imaging of Io’s surface using adaptive
optics at visible wavelengths.
Toxic effects of heavy metals : Lead and Arsenicsanjana502982
Heavy metals are naturally occuring metallic chemical elements that have relatively high density, and are toxic at even low concentrations. All toxic metals are termed as heavy metals irrespective of their atomic mass and density, eg. arsenic, lead, mercury, cadmium, thallium, chromium, etc.
Nutraceutical market, scope and growth: Herbal drug technologyLokesh Patil
As consumer awareness of health and wellness rises, the nutraceutical market—which includes goods like functional meals, drinks, and dietary supplements that provide health advantages beyond basic nutrition—is growing significantly. As healthcare expenses rise, the population ages, and people want natural and preventative health solutions more and more, this industry is increasing quickly. Further driving market expansion are product formulation innovations and the use of cutting-edge technology for customized nutrition. With its worldwide reach, the nutraceutical industry is expected to keep growing and provide significant chances for research and investment in a number of categories, including vitamins, minerals, probiotics, and herbal supplements.
THE IMPORTANCE OF MARTIAN ATMOSPHERE SAMPLE RETURN.Sérgio Sacani
The return of a sample of near-surface atmosphere from Mars would facilitate answers to several first-order science questions surrounding the formation and evolution of the planet. One of the important aspects of terrestrial planet formation in general is the role that primary atmospheres played in influencing the chemistry and structure of the planets and their antecedents. Studies of the martian atmosphere can be used to investigate the role of a primary atmosphere in its history. Atmosphere samples would also inform our understanding of the near-surface chemistry of the planet, and ultimately the prospects for life. High-precision isotopic analyses of constituent gases are needed to address these questions, requiring that the analyses are made on returned samples rather than in situ.
2. CONTENTS
Introduction
Pathways connecting endodontic and periodontal tissues
Etiology of endo-period lesions
Classification of endo-perio lesions
Clinical diagnostic procedures
Differences b/w periodontal and periapical abscess
Endo-perio controversy
Therapeutic management of pulpal and periodontal diseases
Conclusion
References
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3. INTRODUCTION
Endodontic-periodontal problems are responsible for more than 50% of tooth mortality today.
In 1919 Turner and Drew first described the effect of periodontal disease on the pulp. The
relationship between the periodontium and the pulp was first discovered by Simring and
Goldberg in 1964.
Since then, the term ‘endo- perio lesion’ has been used to describe lesions due to inflammatory
products found in varying degrees in both periodontium and pulpal tissues.
The pulp and periodontium have embryonic, anatomic and functional interrelationship.
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4. PATHWAYS CONNECTING ENDODONTIC &
PERIODONTAL TISSUES
Anatomical pathways:
Apical foramen, accessory canals /lateral canals
Congenital absence of cementum exposing
dentinal tubules
Developmental grooves
Non-physiological pathways:
iatrogenic root canal perforations
vertical root fractures caused by trauma,
pathway created due to resorption etc.
3/27
7. Most of the species that have
been found in infected root
canals can also be present in
the periodontal pocket.
(Moore 1987, Sundqvist
1994).
Rupf et al (2000) studied the profiles
periodontal pathogens in pulpal and
periodontal diseases associated with the
same tooth and concluded that
periodontal pathogens often
accompany endodontic infections
Didilescu AC et al (2012) - F.
nucleatum, P. micra and C.
sputigena may play a role in
the pathogenesis of endo-
periodontal lesions.
6/27
8. CLASSIFICATION OF ENDO- PERIO LESIONS
I. Based on etiology, diagnosis, treatment and prognosis
(by Simon, 1972)
Primary endodontic lesions
Primary endodontic lesions with secondary
periodontal involvement
Primary periodontal lesions
Primary periodontal lesions with secondary
endodontic involvement
True combined lesions
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9. II. Based on clinical presentation strategies for each (by Weine, 1982)
Class 1 -tooth that clinically and radiographically stimulate
periodontal involvement but is truly due to pulpal inflammation or
necrosis.
Class II – tooth with both pulpal and periodontal disease
concomitantly
Class III – tooth that has no pulpal problem but requires endodontic
therapy with root amputation to receive periodontal healing
Class IV- tooth that clinically and radiographically stimulate pulpal or
periapical disease but in fact has periodontal disease.
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10. IV. Stock (1988) modified Simon’s classification
Omitted Class V of the classification.
He argued that both Class II and Class IV lesions in advanced
stages can become combined lesions and therefore a
class to describe these lesions was not necessary.
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11. III. Based on treatment plan (Grossman classification,1991)
Type 1 – Requiring endodontic treatment only.
Type II – Requiring periodontal treatment only.
Type III – Requiring combined endo-perio treatment
10/27
12. V. Classification as recommended by the World Workshop for Classification
Periodontal Diseases (1999)
Endodontic-periodontal lesion
Periodontal-endodontic lesion
Combined lesion
11/27
13. DIAGNOSTIC PROCEDURES USED TO IDENTIFY
THE ENDO-PERIO LESION
Examination/
tests
1º endodontic
lesion
1º periodontal
lesion
1º endodontic
2º periodontal
1º periodontal
2º endodontic
True combined
lesion
Visual Soft tissue -
sinus opening
Tooth -
decay/ large
restoration/
fractured
restoration or
tooth/
erosions/abrasio
ns/cracks/
discolorations/
poor RCT
Inflamed
gingiva/
recession
(multiple
teeth)
Plaque &
subgingival
calculus
(multiple
teeth)
swelling
indicating
periodontal
abscess
Plaque forms
at the
gingival margin
of the sinus tract
leads to
inflammation
of marginal
gingiva
exudate
Root
perforation/
fracture
plaque,
subgingival
calculus &
swelling
(multiple
teeth)
pus, exudate
localized/
generalised
recession &
exposure of
root
Plaque,
calculus &
periodontitis will
be present in
varying degrees
Swelling
around single
or multiple
teeth
pus, exudate
12/27
14. Examination/
tests
1º endodontic
lesion
1º periodontal
lesion
1º endodontic
2º periodontal
1º periodontal
2º endodontic
True combined
lesion
Pain Sharp Usually dull
ache
Sharp only in
acute
condition
Usually sharp
shooting
Dull ache in
chronic
conditions
Usually dull
ache
Sharp only in
acute
periodontal
abscess
Dull ache
usually
Only in acute
conditions it
is severe
Palpation does not indicate
whether
the inflammatory
process is
of endodontic or
periodontal
origin
Pain on Pain on Pain on Pain on
Percussion Normally tender
percussion
sensitivity of the
proprioceptive
fibers in an
inflamed pdl will
help identify
the location of
the pain
Tender on
percussion
Tender on
percussion
Tender on
percussion
13/27
15. Examination/
tests
1º endodontic
lesion
1º periodontal
lesion
1º endodontic
2º periodontal
1º periodontal
2º endodontic
True combined
lesion
Mobility Fractured roots and
recently
traumatized teeth
often present high
mobility
Localized to
generalized
mobility of teeth
Localized
mobility
Generalized
mobility
Generalized
mobility with
higher grade of
mobility related
to the involved
tooth
Pulp vitality
test,
A lingering
response-
rreversible pulpitis
No response -
Necrotic pulp
(non-vital)
pulp is vital and
responsive to
testing
Pulp vitality tests
negative
Pulp vitality may
be positive in
multirooted teeth
Usually negative
because
of non-vital pulp.
Pocket probing A deep narrow
solitary pocket*
Multiple wide
deep
pockets
Presence of
solitary wide
pocket
Presence of
multiple
wide and deep
periodontal
pockets
Probing reveals
typical conical
periodontal type
of probing
14/27
16. Examination/
tests
1º endodontic
lesion
1º periodontal
lesion
1º endodontic
2º periodontal
1º periodontal
2º endodontic
True combined
lesion
Sinus tracing A radiograph with
GP points to apex
or furcation area in
molars
Sinus tract mainly
at the
lateral aspect of
the root
Sinus tract mainly
at the apex/
furcation
area
Sinus tract mainly
at the lateral
aspect of the root
Difficult to trace
out the origin of
the lesion *
Radiographs
Cracked tooth
testing
Painful response on
chewing
No symptoms Painful response
on chewing
No symptoms Painful response
on chewing
15/27
17. DIFFERENCES BETWEEN PERIODONTAL AND
PERIAPICAL ABSCESS
PERIODONTAL ABSCESS PERIAPICAL ABSCESS
Periodontal pocket is present caries/ fracture is present
May occur after periodontal treatment May occur after endodontic or restorative
Tooth is vital Tooth is non - vital
Pain is usually dull and localized Pain is severe and difficult to localize
Swelling is present on the lateral surface of root
usually without fistulous track as abscess usually
drains from pocket opening.
Swelling is present at the apical portion of tooth
which drains by formation of a fistulous track.
Tender on lateral percussion Tender on vertical percussion
Usually not visible on radiographs Appears as a periapical radiolucency
16/27
18. ENDODONTIC PERIODONTAL-CONTROVERSY
• Two basic questions have been raised and continue to
be a matter of dispute :
1) Is periodontal disease a cause of pulp necrosis?
2) Can a pulpless tooth be the cause of periodontal
disease?
17/27
19. EFFECT OF PULPAL DISEASE ON THE
PERIODONTIUM
Bacteria and toxic irritants in pulp increase intrapulpal pressure. Inc pressure may cause toxic
to be expressed through patent channels which results in retrograde periodontitis.
Unresolved endodontic lesion causes bone loss, pocket formation and impair wound healing.
Potential effect of tooth with a necrotic pulp has been described as a risk factor (Jansson,
Ehnevid and Blomlof 1998) in the initiation and progression of periodontal disease, and the
initiation of periodontal pockets.
Diem et al (2002) reported that all tissues of the periodontium had a potential for regeneration
regardless of the status of the pulp.
18/27
20. INFLUENCE OF ENDODONTIC PROCEDURES
ON PERIODONTIUM
Endodontic therapy adversely affects periodontal healing.
Mechanical preparation, sealers, surgical trauma hinder new bone, cementum and
connective tissue repair.
Precautions to be taken when periodontal therapy to follow endodontic treatment.
Induce less mechanical trauma
Use more biocompatible sealers
19/27
21. CONTRADICTING STUDY
Sanders et al. (1983) reported that after the use of freeze dried bone allograft, 65% of
the teeth that did not have root canal treatment showed complete or greater than 50%
bone-fill in periodontal osseous defects; while only 33% of the teeth which had root
canal treatment prior to the periodontal surgical procedure had complete or greater
than 50% bone-fill.
20/27
22. EFFECT OF PERIODONTITIS ON THE PULP
Result in atrophic and other degenerative changes like
reduction in the number of pulp cells,
dystrophic mineralization,
fibrosis,
reparative dentin formation,
inflammation and
resorption.
CAUSE:
Disruption of blood flow through the lateral canals localized areas of coagulation
necrosis in the pulp.
21/27
23. Seltzer et al (1978) found
inflammatory alterations
and localized pulp
necrosis adjacent to
lateral canals in roots
exposed by periodontal
disease.
Mazur and Massler (1979)
found that only
periodontitis involving
apical foramen can lead
to pulp necrosis.
Cohen, 2002 have suggested that
periodontal disease causes pulpal
necrosis. Periodontal disease is a
direct cause of pulpal atrophy
necrosis.
22/27
24. EFFECT OF PERIODONTAL PROCEDURES ON
PULP
Scaling and root planing: removes the
bacterial plaque and calculus. However,
improper root planing procedures can also
remove cementum and the superficial parts
of dentin, thereby exposing the dentinal
tubules to the oral environment.
Acid etching: citric acid removes the smear
layer, an important pulp protector.
Application of citric acid may have a
detrimental effect on the dental pulp.
23/27
25. CONTRADICTING STUDIES
Kirkham (1975) studied 100
periodontally involved
& found 2% had lateral
canals in the periodontal
pocket.
Tagger & Smukler (1979)
removed roots from
extensively involved with
periodontal disease in
which root amputation was
necessary. Pulps of these
showed no inflammatory
changes.
Mazur and Massler (1979) found
no relationship and disclaimed
relationship of periodontal
disease as a causative factor in
pulpal disease.
24/27
27. CONCLUSION
Endo perio lesions present challenges to the clinicians in their proper diagnosis,
treatment and prognosis of the involved teeth.
They have a varied pathogenesis which ranges from quite simple to relatively
complex.
Knowledge of these diseases is essential in coming to the correct diagnosis and proper
treatment plan.
26/27
28. REFERENCES
Carranza, Newman 1Oth edition. Endodontic and Periodontics consortium.
Jan Lindhe. Endodontics and Periodontics. Clinical Periodontology and Implant Dentistry.
318-351.
Shalu Bathla, PERIODONTICS REVISITED – 1st edition.
Parolia A, Gait TC, Porto IC, Mala K. Endo-perio lesion: A dilemma from 19th until 21st
century. J Interdiscip Dentistry 2013;3: 2-11.
Syed Wali Peeran et al, endo- perio lesions, international journal of scientific & technology
research volume 2, issue 5, may 2013
27/27
Editor's Notes
Endodontics deals with disease of the pulp and periapical tissues and periodontal therapy deals with many aspects of the supporting strs including the prevention and repair of gingival sulcus. The success of both periodontal and endodontic therapy depends on the elimination of both disease processes, whether they exist separately or as a combined lesion.
Ectomesenchymal cells proliferate to form dental papilla and follicle which are the precursors of periodontium and pulp resp. this embryonic development gives rise to anatomical connections which remain throughout life.
Inflammation frm pulp may extends into the periodontium causing destruction of periodontal tissues such a periodontal lesion is kas retrograde periodontitis.
Retrograde pulpitis occurs as a result of extension of inflammation from periodontal tissues into the pulp.
A. actinomycetemcomitans Capnocytophaga sp. F. nucleatum P. gingivalis P. intermedia T. forsythia T. denticola
most accepted classification
Acute conditions: anug, acute periodontal abscess, acute herpetic gingivostomatits
Palpation is performed by applying firm digital pressure to mucosa covering the roots and apices. With the index finger the mucosa is presses against the underlying cortical bone. This will detect the presence of periradicular abnormalities that produce painful response to digital pressure. A positive response to palpation may indicate active periradicular inflammatory process. However this test doesnot indicate whether the inflammatory process is of endodontic or periodontal origin.
Percussion is performed by tapping on the incisal or occlusal surfaces of the teeth with the back of mirror handle the tooth is tapped vertically and horizontally.
*in the absence of periodontal disease may indicate the presence of a lesion of endodontic origin or a vertical root fracture
Mobility testing can be performed using 2 mirror hanles on each side of the crown. Pressure is applied in facial- lingual as well as in a vertical direction and tooth mobility is scored.
deep carious lesions/defective restorations/previous poor RCT 2. vertical bone loss 3. root resorption with a wide base radiolucency around the apex of the
Root 4 . Angular bone loss in multiple teeth 5. may be similar to that of a vertically fractured tooth
* if a sinus tract is present, it may be necessary to raise a flap to determine the etiology of the lesion
First indication of periodontal involvement due to pulp disease is thickening of PDL space at the apical end.
Nature and extent of periodontal ligament destruction is dependent on several factors like virulence of bacteria, duration of the disease and host defense mechanism.
Clinical message of these studies was that root canal treatment should be completed before periodontal therapy.
Biocompatibility is related to the behavior of biomaterials in various contexts. The term refers to the ability of a material to perform with an appropriate host response in a specific situation Sealapex Obtuseal root canal sealer
. Subsequent microbial colonization of the root dentin may result in bacterial invasion of the dentinal tubules. As a consequence, inflammatory lesions may develop in the pulp. The initial symptom is sharp pain of rapid onset that disappears once the stimulus is removed.
During periodontal regenerative therapy, root conditioning using citric acid helps to remove bacterial endotoxin and anerobic bacteria and to expose collagen bundles to serve as a matrix for new connective tissue attachment to cementum. Though beneficial in the treatment of periodontal disease,