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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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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.
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ETIOLOGICAL AND CONTRIBUTING FACTORS
IN ENDO-PERIO LESIONS
BACTERIA ASSOCIATED WITH
5/27 PULPITIS
Class III –Tooth that has no pulpal problem but requires endodontic
therapy plus root amputation to gain periodontal healing.
Endodontic-periodontal lesion
Periodontal-endodontic lesion
Combined lesion
DIAGNOSTIC PROCEDURES USED TO
12/27 IDENTIFY THE ENDO-PERIO LESION
Examination/ 1º endodontic 1º periodontal 1º endodontic 1º periodontal True combined
tests lesion lesion 2º periodontal 2º endodontic lesion
Pain Sharp Usually dull Usually sharp Usually dull Dull ache
ache shooting ache usually
Sharp only in Dull ache in Sharp only in Only in acute
acute chronic acute conditions it
condition conditions periodontal is severe
abscess
Palpation does not indicate Pain on Pain on Pain on Pain on
whether
the inflammatory
process is
of endodontic or
periodontal
origin
Percussion Normally tender Tender on Te nder on Tender on Tender on
percussion percussion percussion percussion percussion
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Examination/ 1º endodontic 1º periodontal 1º endodontic 1º periodontal True combined
tests lesion lesion 2º periodontal 2º endodontic lesion
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Examination/ 1º endodontic 1º periodontal 1º endodontic 1º periodontal True combined
tests lesion lesion 2º periodontal 2º endodontic lesion
Sinus tracing A radiograph with Sinus tract mainly Sinus tract mainly Sinus tract mainly Difficult to trace
GP points to apex at the at the apex/ at the lateral out the origin of
or furcation area in lateral aspect of furcation aspect of the root the lesion *
molars the root area
Radiographs
Cracked tooth Painful response on No symptoms Painful response No symptoms Painful response
testing chewing on chewing on chewing
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DIFFERENCES BETWEEN PERIODONTAL AND
PERIAPICAL ABSCESS
PERIODONTAL ABSCESS PERIAPICAL ABSCESS
May occur after periodontal treatment May occur after endodontic or restorative
Pain is usually dull and localized Pain is severe and difficult to localize
Swelling is present on the lateral surface of root Swelling is present at the apical portion of tooth
usually without fistulous track as abscess usually which drains by formation of a fistulous track.
drains from pocket opening.
Tender on lateral percussion Tender on vertical percussion
TREATMENT
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CONCLUSION