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periodontitis associated with endodontic lesions

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Parth Thakkar
Parth Thakkar
Health & Medicine
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Periodontitis Associated with Endodontic Lesions
[object Object],[object Object],Periodontic-Endodontic Lesions
[object Object],Periodontic-Endodontic Lesions
Anatomical Pathways Connecting Endodontic & Periodontal Tissues ,[object Object],[object Object],[object Object],[object Object]
8.8 % 1.6 % 17 % Frequency of Accessory Canals ,[object Object],[object Object],De Deus, 1975
Accessory Canals ,[object Object],[object Object],bacterial byproducts that could reach the periodontium through accessory canals.
Dentinal Tubules ,[object Object],[object Object]
Dentinal Tubules Vs. Accessory Canals Dentinal Tubules Accessory Canal
Furcation Foramina
[object Object],[object Object],Simon et al (1972) Classification
Simon et al (1972) Endodontic lesions with secondary periodontic involvement COMBINED LESIONS (“True” combined lesions) ENDODONTIC LESIONS PERIODONTIC LESIONS Periodontic lesions with secondary endodontic involvement
Primary Endodontic Lesion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Drainage of endodontic abscess into the sulcus follows one or two routes: Extraosseous fistulation Periodontal ligament fistulation
 
Effect of Pulpal Disease on the Periodontium ,[object Object],[object Object]
Periodontal ligament Fistulation
Primary Endodontic Lesion w/Secondary Periodontal Involvement ,[object Object]
Calculus If this lesion was considered for endodontic treatment – it is necessary to complete “closed” root planing if there is to be any osseous regeneration
Retrograde Periodontitis ,[object Object]
Primary Periodontal Lesion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Primary Periodontic Lesion w/Secondary Endodontic Involvement ,[object Object],[object Object]
Primary Perio Lesion W/ Secondary Pulpal Disease
“ True” Combined Lesions ,[object Object],[object Object],[object Object]
TRUE COMBINED
Pathogenesis Pulpal disease Periodontal disease SHARED ETIOLOGY Microbiologic Immunologic
Microbiology ,[object Object],SPIROCHETES Fusobacterium Prevotella Porphyromonas Peptostreptococcus Eubacterium Capnocytophaga Lactobacillus
Microbiology ,[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Predisposing Factors that Contribute to Endo- Perio Lesions
Palato-Gingival Grooves ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Kogan,1986
Trauma-Induced Root Resorption ,[object Object],[object Object],[object Object],[object Object]
 
Cracked Tooth ,[object Object],[object Object]
Vertical Root Fracture ,[object Object],[object Object]
Vertical Root Fracture
 
 
Root Perforations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Endodontic Therapy ,[object Object],[object Object]
Effects of Periodontal Disease on the Pulp ,[object Object],[object Object],[object Object],[object Object],[object Object]
Effect of Perio Tx on the Pulp ,[object Object],[object Object],*Bergenholtz and Lindhe,1978 **Mazur and Massler, 1964 Czarnecki and Schilder, 1979 Torabinejad and Kiger,1985
Effect of Endo Tx on the Periodontium ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnosis
 
Diagnostic Considerations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnostic Considerations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment ,[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],Treatment
Endodontic Lesion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Endodontic Lesion with secondary Periodontal disease ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Periodontal lesion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Periodontal Lesion with secondary Endodontic disease ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Combined Lesion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],Treatment
[object Object],[object Object],Periodontic-Endodontic Lesions

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periodontitis associated with endodontic lesions

Editor's Notes

  1. The surgical support necessary to alter the dento-gingival complex has been oversimplified. The request from the restorative dentist to merely crown lengthen # 6-11 is inadequate communication. This review will focus on the clinical techniques necessary to establish predictable combined periodontal and restorative results.
  2. Pulpal disease shares an identical etiology with periodontal disease. Both entities have Microbiologic and Immunologic/ Histopathologic features in common.
  3. Microbiota in necrotic pulps is not as complex (1 or 2 species may predominate)
  4. http://crse-nt.dent.umich.edu/Endo/814/EndoPerio/sld035.htm
  5. http://crse-nt.dent.umich.edu/Endo/814/EndoPerio/sld012.htm
  6. Pack AR; Chandler NP. A combined endodontic-periodontic lesion of developmental origin: a case report. NZ Dent J 92: 46-48, 1996. Kerekes K, Olsen I. Similarities in the microfloras of root canals and deep periodontal pockets. Endod Dent Traumatol 6: 1-5, 1990. Jansson L, Ehnevid H, Lindskog S, Blomlöf L. Relationship between periapical and periodontal status. A clinical retrospective study. J Clin Periodontol 22: 598-602, 1995
  7. Pack AR; Chandler NP. A combined endodontic-periodontic lesion of developmental origin: a case report. NZ Dent J 92: 46-48, 1996. Kerekes K, Olsen I. Similarities in the microfloras of root canals and deep periodontal pockets. Endod Dent Traumatol 6: 1-5, 1990. Jansson L, Ehnevid H, Lindskog S, Blomlöf L. Relationship between periapical and periodontal status. A clinical retrospective study. J Clin Periodontol 22: 598-602, 1995