How to diagnose and treat periodontal endodontic lesions. Endodontic periodontal combined lesion is a clinical dilemma because making a differential diagnosis and deciding a prognosis are difficult. A new classification of endodonticperiodontal lesions khalid s. The initial task of treating endodontic periodontal. Endo perio lesion a case report journal of medical biomedical. If we were to look at endoperio lesions that began from the endodontic tissue, there are a number of potential causes. The nature of that pain is often the first clue in determining the etiology of such a problem. Differential diagnosis of endo perio lesions 16 primary endodontic disease. Endoperio lesions primarily occur by way of the intimate anatomic and vascular connections between the pulp and the periodontium. The simultaneous involvement of pulpal problems and inflammatory periodontal disease can complicate. Cases with endodontic periodontal lesions usually present with several clinical and radiological features, such as altered response to testing of pulp sensitivity, clinical signs of gingival inflammation, increased probing pocket depth, sinus tracts, pus secretion and different types of radiological bony defects, several areas of the dentition show periodontal involvement, all of which. Knowledge of these disease processes is essential in coming to the correct diagnosis. It is possible for an acute exacerbation of a chronic periapical lesion on a tooth with a necrotic pulp to drain through the pdl into the.
An endo perio lesion is one of the most common problems encountered in the day today practice. Endodontic radiology, 2nd edition, is a unique reference that examines all aspects of radiographic imaging related to endodontics. The results support the suggestion that the source of endodontic infection in endodontic periodontic lesions of primary periodontal etiology is the periodontal pocket. Pdf endoperio lesions are occasionally encountered complicated dental conditions, difficult to diagnose and treat.
Endoperio lesions are occasionally encountered complicated dental conditions, difficult to diagnose and treat. Syed wali peeran, madhumala thiruneervannan, khaled awidat abdalla, marei hamed mugrabi. A 50yearold female patient with uncontrolled diabetes type 2 is suffering from a purulent discharge coming from the upper right canine. A symptomatic tooth may have pain of periodontal andor pulpal origin.
Pdf etiology and classification of endodonticperiodontal lesions. Endo perio lesions are a common finding in the dental practice. A diagram that summarises lesion development the relationships between them. The followup radiographs showed complete healing of the hard and soft tissue lesions. A new classification of endodonticperiodontal lesions. Unlimited viewing of the articlechapter pdf and any associated supplements and figures. As you can we have a diagnostic dilemma, if the perio endo lesion has advanced to the point that the pulp is nonvital.
Combined periodontic endodontic lesions take the form of abscesses and can originate from either or both of two distinct locations and may be informally subclassified as follows. A perio endo lesion can have a varied pathogenesis which ranges from quite simple to relatively complex one. For differential diagnosis and treatment purposes, endo perio lesions are classified as either. Differentiating between a periodontal and an endodontic problem can be difficult. This article is from journal of clinical and experimental dentistry, volume 6. Pdf endodonticperiodontal lesions occur as a combination of an endodontic infection and periodontal disease in. Singlerooted teeth have a less favorable prognosis than multirooted teeth because the latter can undergo root resection as an alternative treatment. From the diagnostic point of view, it is important to realize that as long as the pulp remains vital, although inflamed. The subject of combined endo perio lesions is surrounded by considerable confusion. Specific endodontic, prosthetic, and periodontal considerations that should be incorporated into clinical decision making and treatment planning are then discussed in detail.
Etiologic factors such as bacteria, fungi, and viruses as well as various contributing factors such as trauma, root resorptions, perforations, and dental malformations play an important role in the development and progression of such lesions. Management of endodonticperiodontic lesions springerlink. The success of management of a combined periodontal and endodontic lesion depends on the elimination of both of the disease processes. An essential primer to clarify diagnosis and treatment of endoperiodontal lesions. Bettina basrani and a team of prestigious international contributors build upon traditional radiographic techniques and include the latest information available on digital radiographs and cone beam computed tomography. These lesions are primarily caused by periodontalpathogens. A practical way to classify endo perio lesions for treatment planning purposes is to separate into three broad categories. The complexity of endo perio lesions reflects the relevance of a close developmental. An endo perio lesion can have a varied pathogenesis which ranges from simple to relatively complex one. This case report evaluates the prognosis of endo perio lesion which was first treated with conventional endodontic therapy and then followed by periodontal. Pdf periodontal aspects of endodonticperiodontal lesions. Endoperio lesions periodontology notes dentalnotebook.
In this report, we present several treatment modalities in. Pdf a new classification of endodonticperiodontal lesions. Simon endodontic periodontal lesions present challenges to the clinician as. Endodontic periodontal diseases often present great challenges to the clinician in their diagnosis, management, and prognosis. There does not seem to be a direct association between the local humoral immune response and cultivable microflora in the endodontic periodontic lesion, a situ ation similar to.
Jffa aza syd page 2 pulpoperiodontal problems perio endo lesion periodontitis by extension of inflammation from the gingiva into deeper periodontal tissues. The simultaneous involvement of pulpal problems along. Based on these classifications, the most widely used classification of endodontic periodontal lesions is the one that has been classified by simon et al. Typically, endodontic lesions resorb bone apically and laterally and destroy the attachment apparatus adjacent to a nonvital tooth. The author discusses the different origins of endo perio lesions and the importance of diagnosing the source of the lesion to allow appropriate.
Colleagues for excellence 4 condensing osteitis is a diffuse radiopaque lesion representing a localized bony reaction to a lowgrade inlammatory stimulus usually seen at the apex of the tooth. One frequently hears diagnoses of endo perio lesions when in fact there is an endodontic lesion mimicking periodontal disease or, vice versa, a purely periodontal lesion perfectly is camouflaged as an endodontic pathology. In this report the pulp vitality test which showed the nonvital nature of the tooth was a pivoting finding suggesting the primary endodontic involvement. A sequential approach in treatment of endoperio lesion a. These endodontic lesions are compared with primary periodontal lesions and primary periodontal lesions with secondary endodontic participation. The prognosis and treatment of each endodontic periodontal. In this case report, different kinds of endo perio lesion were treated with sequential endodontic and periodontal treatment.
Whereas the endo perio lesion will often produce resolution of the joint problem with endodontic treatment alone, the perio endo lesion will still require periodontal treatment and even then the prognosis is far poorer. This is achievable by careful history taking, examination and the use of special tests. Endodontic periodontal relationship, endo perio lesion. Abundant case documentation illustrates the close connection between the dental pulp and the periodontium and shows the variety of clinical situations in which this dualnatured pathology can present.
This work is to discuss the management of an endo perio lesion, which represents a challenge to clinicians when it comes to diagnosis and prognosis of the involved teeth and especially with an altered general condition. Endodonticperiodontal lesions pdf this book presents a multidisciplinary evidencebased approach to the management of teeth with lesions of endodontic periodontal origin. In this process, chronic periodontitis progresses apicallyalong the root surface. A symptomatic tooth may have pain of periodontal andor pulpal. Differentiating between periodontal and endodontic problems can be difficult. Introduction primary pulpal infection leading to periradicular periodontitis both infections occur simultaneously as independent perio and endo lesions primary periodontal infection causing breakdown of alveolar crestal bone, leading all the way to apex the two infections coalesce to. In most cases, pulp tests indicate a clinically normal pulpalreaction. Divya bhat abstract an endo perio lesion has been one of the most common problems associated with the tooth. Lesions of the periodontal ligament and adjacent alveolar bone may originate from infections of the periodontium or tissues of the dental pulp. A retrospective study of blomlof concluded that the endodontic infection promotes periodontal pocket formation and is a risk factor in the progression of periodontitis, so, a primary endodontic lesion draining through the attachment apparatus should be initially treated by an endodontic treatment, since an aggressive removal of the periodontal ligament and cementum. Mandibular right irst molar had been hypersensitive to cold and sweets over the.
Endodontic periodontal lesions present challenges to the clinician as far as diagnosis and prognosis of the involved teeth are concerned. Understanding the disease process through causeandeffect relationships between the pulp and supporting periodontal tissues with the aid of rational classifications leads to successful treatment outcomes. The prognosis for successful management is highly dependent on proper initial classification and subsequent sequencing of treatment. Endodontic periodontal lesions are complicated disease entity, frequently encountered in daytoday dental practice, difficult to diagnose and treat. The book opens by addressing the etiology and classification of endodonticperiodontal lesions, and demonstrates its relevance to the daily practice. Abstractpulpal and periodontal problems are responsible for more than half of the. Generally, in a case of combined endo perio lesion, an adequate endodontic therapy would. And the missing patterns of endo perio lesions were identified, and then. The interrelationship between periodontal and endodontic disease has always aroused confusion, queries, and controversy. The prognosis for a tooth with periodontal disease is determined by the result of the periodontal therapy. Endodontic periodontal lesionwith primary endodontic lesions andsecondary periodontal involvement of 16 16. The periodontal endodontic lesion develops by extension of either periodontal destruction apically combining with an existing periapical lesion or an endodontic lesion marginally, combining with an existing periodontal lesion. A case series associated with different kinds of endo.