IIDC 2013

1. SHAKING HANDS “PERIO-
ENDO
INTERRELATIONSHIP”
Periodontium and the pulp are intimately related.
Periodontium and the pulp are intimately related.
Lesions of the periodontal ligament and alveolar
Lesions of the periodontal ligament and alveolar
bone may originate from infections of the
bone may originate from infections of the
periodontium or tissues of the dental pulp.
periodontium or tissues of the dental pulp.
Periodontal-Endodontic lesions often present
Periodontal-Endodontic lesions often present
challenge to the clinicians. Due to the complexity of
challenge to the clinicians. Due to the complexity of
these affections, an interdisciplinary approach with
these affections, an interdisciplinary approach with
a good collaboration between periodontists and
a good collaboration between periodontists and
endodontists is required.
endodontists is required.
Slide No. 1 Dr. RUCHIKA JASWAL Poster No. 12

2. Inter Relationship between Pulpal & Periodontal
tissues
EFFECT OF PERIODONTAL TREATMENT ON DENTAL PULP
EFFECT OF PERIODONTAL TREATMENT ON DENTAL PULP
Improper root planing can in advertently remove healthy cementum && superficial
Improper root planing can in advertently remove healthy cementum superficial
dentinal surface leading to bacterial invasion of the dentinal tubules; thus causing
dentinal surface leading to bacterial invasion of the dentinal tubules; thus causing
development of inflammatory lesion in pulp.
development of inflammatory lesion in pulp.
Root conditioning during periodontal regenerative therapy removes the pulp
Root conditioning during periodontal regenerative therapy removes the pulp
protecting; smear layer.
protecting; smear layer.
Slide No. 2 Dr. RUCHIKA JASWAL Poster No.12

3. Simring and Goldberg (1964) were first to describe the relationship between
periodontal and pulpal dieases. Since then, the term, 'perio-endo lesion' has been
used to describe lesions of both the periodontium and the pulpal tissues.
CLASSIFICATION OF PERIO-ENDO LESIONS (Simon JH, Glick DH & Frank AL
1972)
PATHWAYS OF COMMUNICATION (Zehnder M, Gold SI, Hasselgren G 2002):
Anatomical pathways: Non-physiological pathways:
Apical foramen Iatrogenic root canal perforations
Lateral canals & Pathway created by vertical root fractures
Tubular pathways
Slide No. 3 Dr. RUCHIKA JASWAL Poster No.12

4. CHARACTERISTICS OF PERIO-ENDO LESIONS
LESION PAIN SWELLING PERIODONTAL POCKETING RADIOGRAPHIC VITALITY
Primary periodontic None-moderate Possible Moderate Decreased crestal bone height Vital
Primary periodontic- None unless acute endo Possible Severe Bone loss approaching apex Vital
secondary endodontic
Primary endodontic Moderate-severe Possible None unless sinus tract Possible periapical radiolucency Non-vital
Primary endodontic- Moderate-severe Likely Evident or sinus tract Radiolucency from apex to sulcus, Non-vital
secondary periodontic decreased crestal bone height
Combined periodontal Moderate-severe Likely Severe, connects with periapex Bone loss extending to apex Non-vital
&endodontic
Slide No. 4 Dr. RUCHIKA JASWAL Poster No.12

5. TREATMENT
Primary periodontal lesions:
Phase I therapy
Periodontal surgery, if indicated
Primary endodontic lesions:
Root canal treatment
Iatrogenic lesions:
Treated according to their aetiology
Commense endodontic treatment
first, main aim is to produce a seal
True combined lesions:
Root amputation, hemisection
Increase bony support; bone
grafting, guided tissue regeneration
Slide No. 5 Dr. RUCHIKA JASWAL Poster No.12

6. NEWER TREATMENT MODALITY
Use of soft tissue lasers (Nd:YAG, Diode laser)
• Is more effective,
• Less traumatic than conventional surgical methods,
• Less postoperative swelling,
• Have affinity for hemoglobin and gingival pigments making soft tissue separation precise, seal blood vessels &
decontaminate the area and also reduces postoperative swelling.
Preoperative photograph. Radiograph showing root canal
Postoperative photograph of
Vertical bone loss of about 4- treatment done. Subgingival
maxillary left CI with All-ceramic
5mm (white arrow) and Curettage Done with a Diode
replacement resorption. Laser. crown.
CONCLUSION
CONCLUSION
A perio-endo lesion can have aa varied pathogenesis which has aroused much speculation,
A perio-endo lesion can have varied pathogenesis which has aroused much speculation,
confusion, and controversy. Having enough knowledge of these disease processes is essential for aa
confusion, and controversy. Having enough knowledge of these disease processes is essential for
correct diagnosis. ItItis thus, important to remember that the recognition of pulp vitality is essential for
correct diagnosis. is thus, important to remember that the recognition of pulp vitality is essential for
aa differential diagnosis and for the selection of primary measures for treatment of inflammatory
differential diagnosis and for the selection of primary measures for treatment of inflammatory
lesions in the marginal and apical periodontium.
lesions in the marginal and apical periodontium.
Slide No. 6 Dr. RUCHIKA JASWAL Poster No.12

7. NEWER TREATMENT MODALITY
Use of soft tissue lasers (Nd:YAG, Diode laser)
• Is more effective,
• Less traumatic than conventional surgical methods,
• Less postoperative swelling,
• Have affinity for hemoglobin and gingival pigments making soft tissue separation precise, seal blood vessels &
decontaminate the area and also reduces postoperative swelling.
Preoperative photograph. Radiograph showing root canal
Postoperative photograph of
Vertical bone loss of about 4- treatment done. Subgingival
maxillary left CI with All-ceramic
5mm (white arrow) and Curettage Done with a Diode
replacement resorption. Laser. crown.
CONCLUSION
CONCLUSION
A perio-endo lesion can have aa varied pathogenesis which has aroused much speculation,
A perio-endo lesion can have varied pathogenesis which has aroused much speculation,
confusion, and controversy. Having enough knowledge of these disease processes is essential for aa
confusion, and controversy. Having enough knowledge of these disease processes is essential for
correct diagnosis. ItItis thus, important to remember that the recognition of pulp vitality is essential for
correct diagnosis. is thus, important to remember that the recognition of pulp vitality is essential for
aa differential diagnosis and for the selection of primary measures for treatment of inflammatory
differential diagnosis and for the selection of primary measures for treatment of inflammatory
lesions in the marginal and apical periodontium.
lesions in the marginal and apical periodontium.
Slide No. 6 Dr. RUCHIKA JASWAL Poster No.12