Etiopathogenesis of

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

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

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
 Kanal Lateral

Lateral Canal

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

FORAMEN APIKAL

Foramen Apical
Etiologic factor (Living pathogens)
• Bacteria
Bakter
• Fungi
Jamur
• Virus
i
Virus
Bakteri

Spirochetes sp. Prevotella intermedia

Jamur

Candida albicans
Virus

Herpes Simplex Virus

Etiologic factor (non living
Pathogens)
Benda asing

Epithelial Rest of Mallassez

Kristal Kolesterol
Contributing factors
Perawatan endodontik yang tidak adekuat

Kebocoran koronal

Trauma

Resorpsi

Perforasi

Malformasi developmental
 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
 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-
 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
Ecologic plaque hypothesis
Representasi Initial Events yang Dipicu oleh
LPS dari Plak Biofilm pada Jaringan Periodontal.

1. LPS menginisiasi transduksi sinyal melewati TLR-4

2. Aktivasi makrofag, limfosit, dan sel endotel
3. Pelepasan sitokin proinflamatori
4. PMN sebagai first line defense
5. TNF-a dan IL-1 sebagai mediator resorpsi tulang
6. MMP merusak kolagen
Sistem
Komplemen
Innate & Adaptive
Immune Response in
periodontal disease
Transduksi sinyal oleh PRR dan
MAMP
P. gingivalis
Aktivasi osteoklas akibat mediator
inflamasi
Ringkasan Pengaruh LPS Terhadap
Bone loss
Periodontal Disease cycle
Patogenesis