Dr. Ruchika Jaswal

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IIDC 2013

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Dr. Ruchika Jaswal

  1. 1. SHAKING HANDS “PERIO- ENDO INTERRELATIONSHIP” Periodontium and the pulp are intimately related. Periodontium and the pulp are intimately related. Lesions of the periodontal ligament and alveolar Lesions of the periodontal ligament and alveolar bone may originate from infections of the bone may originate from infections of the periodontium or tissues of the dental pulp. periodontium or tissues of the dental pulp. Periodontal-Endodontic lesions often present Periodontal-Endodontic lesions often present challenge to the clinicians. Due to the complexity of challenge to the clinicians. Due to the complexity of these affections, an interdisciplinary approach with these affections, an interdisciplinary approach with a good collaboration between periodontists and a good collaboration between periodontists and endodontists is required. endodontists is required.Slide No. 1 Dr. RUCHIKA JASWAL Poster No. 12
  2. 2. Inter Relationship between Pulpal & Periodontal tissues EFFECT OF PERIODONTAL TREATMENT ON DENTAL PULP EFFECT OF PERIODONTAL TREATMENT ON DENTAL PULP Improper root planing can in advertently remove healthy cementum && superficial Improper root planing can in advertently remove healthy cementum superficial dentinal surface leading to bacterial invasion of the dentinal tubules; thus causing dentinal surface leading to bacterial invasion of the dentinal tubules; thus causing development of inflammatory lesion in pulp. development of inflammatory lesion in pulp. Root conditioning during periodontal regenerative therapy removes the pulp Root conditioning during periodontal regenerative therapy removes the pulp protecting; smear layer. protecting; smear layer.Slide No. 2 Dr. RUCHIKA JASWAL Poster No.12
  3. 3. Simring and Goldberg (1964) were first to describe the relationship betweenperiodontal and pulpal dieases. Since then, the term, perio-endo lesion has beenused to describe lesions of both the periodontium and the pulpal tissues.CLASSIFICATION OF PERIO-ENDO LESIONS (Simon JH, Glick DH & Frank AL 1972)PATHWAYS OF COMMUNICATION (Zehnder M, Gold SI, Hasselgren G 2002): Anatomical pathways: Non-physiological pathways: Apical foramen Iatrogenic root canal perforations Lateral canals & Pathway created by vertical root fractures Tubular pathwaysSlide No. 3 Dr. RUCHIKA JASWAL Poster No.12
  4. 4. CHARACTERISTICS OF PERIO-ENDO LESIONSLESION PAIN SWELLING PERIODONTAL POCKETING RADIOGRAPHIC VITALITYPrimary periodontic None-moderate Possible Moderate Decreased crestal bone height VitalPrimary periodontic- None unless acute endo Possible Severe Bone loss approaching apex Vitalsecondary endodonticPrimary endodontic Moderate-severe Possible None unless sinus tract Possible periapical radiolucency Non-vitalPrimary endodontic- Moderate-severe Likely Evident or sinus tract Radiolucency from apex to sulcus, Non-vitalsecondary periodontic decreased crestal bone heightCombined periodontal Moderate-severe Likely Severe, connects with periapex Bone loss extending to apex Non-vital&endodontic Slide No. 4 Dr. RUCHIKA JASWAL Poster No.12
  5. 5. TREATMENT Primary periodontal lesions: Phase I therapy Periodontal surgery, if indicated Primary endodontic lesions: Root canal treatment Iatrogenic lesions: Treated according to their aetiology Commense endodontic treatment first, main aim is to produce a seal True combined lesions: Root amputation, hemisection Increase bony support; bone grafting, guided tissue regenerationSlide No. 5 Dr. RUCHIKA JASWAL Poster No.12
  6. 6. NEWER TREATMENT MODALITYUse of soft tissue lasers (Nd:YAG, Diode laser)• Is more effective,• Less traumatic than conventional surgical methods,• Less postoperative swelling,• Have affinity for hemoglobin and gingival pigments making soft tissue separation precise, seal blood vessels &decontaminate the area and also reduces postoperative swelling. Preoperative photograph. Radiograph showing root canal Postoperative photograph of Vertical bone loss of about 4- treatment done. Subgingival maxillary left CI with All-ceramic 5mm (white arrow) and Curettage Done with a Diode replacement resorption. Laser. crown. CONCLUSION CONCLUSION A perio-endo lesion can have aa varied pathogenesis which has aroused much speculation, A perio-endo lesion can have varied pathogenesis which has aroused much speculation, confusion, and controversy. Having enough knowledge of these disease processes is essential for aa confusion, and controversy. Having enough knowledge of these disease processes is essential for correct diagnosis. ItItis thus, important to remember that the recognition of pulp vitality is essential for correct diagnosis. is thus, important to remember that the recognition of pulp vitality is essential for aa differential diagnosis and for the selection of primary measures for treatment of inflammatory differential diagnosis and for the selection of primary measures for treatment of inflammatory lesions in the marginal and apical periodontium. lesions in the marginal and apical periodontium.Slide No. 6 Dr. RUCHIKA JASWAL Poster No.12
  7. 7. NEWER TREATMENT MODALITYUse of soft tissue lasers (Nd:YAG, Diode laser)• Is more effective,• Less traumatic than conventional surgical methods,• Less postoperative swelling,• Have affinity for hemoglobin and gingival pigments making soft tissue separation precise, seal blood vessels &decontaminate the area and also reduces postoperative swelling. Preoperative photograph. Radiograph showing root canal Postoperative photograph of Vertical bone loss of about 4- treatment done. Subgingival maxillary left CI with All-ceramic 5mm (white arrow) and Curettage Done with a Diode replacement resorption. Laser. crown. CONCLUSION CONCLUSION A perio-endo lesion can have aa varied pathogenesis which has aroused much speculation, A perio-endo lesion can have varied pathogenesis which has aroused much speculation, confusion, and controversy. Having enough knowledge of these disease processes is essential for aa confusion, and controversy. Having enough knowledge of these disease processes is essential for correct diagnosis. ItItis thus, important to remember that the recognition of pulp vitality is essential for correct diagnosis. is thus, important to remember that the recognition of pulp vitality is essential for aa differential diagnosis and for the selection of primary measures for treatment of inflammatory differential diagnosis and for the selection of primary measures for treatment of inflammatory lesions in the marginal and apical periodontium. lesions in the marginal and apical periodontium.Slide No. 6 Dr. RUCHIKA JASWAL Poster No.12

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