Endo-Perio

Lesion
Simring, Marvin; Goldberg, Maurice (1964). The Pulpal Pocket Approach:
Retrograde Periodontitis.

I.B. Bender; Samuel Seltzer (1972). The effect of periodontal

disease on the pulp.
Cohen. Cohen’s Pathway of the Pulp.
 Anatomical Consideration

Dentinal Tubules

Accessory Canal/
Lateral Canal

Accessory Canal/
Lateral Canal Foramen Apical

ROTSTEIN I, SIMON JH. The endo-perio lesion: a critical appraisal of the disease
condition. Endod Top. 2006;13(1):34–56.
Dentinal Tubules
• Tubulus dentin yang terbuka di daerah tanpa
sementum dapat berfungsi sebagai jalur komunikasi
antara pulpa dan ligamen periodontal.
• Paparan tubulus dentin dapat terjadi karena :
1. Prosedur terapi periodontal yang agresif
2. Developmental groove
3. Gap joint pada cemento-enamel junction
4. Gum Recession
 Lateral Canal

J Conserv Dent, Apr-Jun 2008, Vol:11, Issue:2

Foramen Apical
 Resorption
Root resorption results in loss of dentin, cementum
and/or bone.
* Non-infective root resorption
1. Transient root resorption/ remodelling resorption –
only seen microscopically
2. Pressure-induced root resorption by tumours,
cysts, excessive orthodontic movements,
succedaneous teeth and impacted teeth
3. Chemical-induced root resorption like bleaching
agents, hydrogen peroxide
4. Replacement root resorption or ankylosis Extra-
canal invasive root resorption
* Infective root resorption
5. Internal resorption
6. External resorption
 Perforation

• They are caused by dental pathologies like

extensive caries or resorption defects that have
perforated through the dentin and into the peri-
radicular tissues. •
• latrogenic perforations:
– Endodontic treatment.
– Periodontal surgical procedures.
• Perforations facilitate the formation of endo-perio
lesions.
 Developmental Malformation
Palato-gingival groove

Dens Invaginatus Dens evaginatus

The relationship between the vital pulp and
the periodontal tissues
The relationship between the non-vital pulp
and the periodontal tissues
Pathogenesis Endodontic Lesions
TERIMA KASIH