#8 pulpo-perio-lesion-4-2.pdf

Dr.Jafar Naghshbandi D.D.S ; M.S, Diplomate Of The American Board Of Periodontology and s Specialist in endodontics whoever taught me a word make me his servant Dr. Raul caffesse Dr. Jim Simon Nobody cares how much you know, until they know how much you care. Theodore...

Dr.Jafar Naghshbandi D.D.S ; M.S, Diplomate Of The American Board Of Periodontology and s Specialist in endodontics whoever taught me a word make me his servant Dr. Raul caffesse Dr. Jim Simon Nobody cares how much you know, until they know how much you care. Theodore Roosevelt.. Developmental Enamel projections grooves and pearls at the cervical portion Accessory canals and lateral canals Apical foramen  Tooth fracture (vertical). Idiopathic resorption can be: From the pulp to the surface of the tooth. From the external surface of the root to the pulp. Both internal and external resorption produces communication. Loss of cementum due to external irritants.. EXPOSURE OF Accidental lateral ROOT FRACTURE DENTINAL TUBULES perforation DUE TO FOLLOWING ROOT during endodontic ENDODONTIC PLANING. procedure PROCEDURE.  The three major causes of pulpal inflammation are: 1.Instrumentation during periodontal, restorative or prosthetic procedures. 2.Progression of dental caries. 3.Tooth fractures.  Bender and Seltzer (1972) in their studies have reported that teeth with caries or restorations also suffering from periodontal disease have more atrophic pulps than teeth with caries or restorations, but no periodontal disease. The cause of these atrophic changes (which is observed radiographically as narrowed canal space) is the disruption of blood flow through the lateral canals, which leads to localized areas of coagulation necrosis in the pulp. Subgingival scaling and root planing may also produce changes in the pulp, one possible explanation for this is that blood vessels leading into lateral canals are severed causing localized areas of pulpal necrosis 1. Primary endodontic lesion. 2. Primary endodontic with secondary periodontal lesion. 3. Primary periodontal lesion. 4. Primary periodontal lesion with secondary 5. endodontic involvement. 6. True combined lesions.  Bacteria play an important role in the pathogenesis of both pulpal and periodontal disease. There seems to be significant similarity between the microbiological findings of root canals and pockets with advanced periodontitis. B. forsythus, P. gingivalis and T. denticola, Fusobacteria, Spirochetes, Wolinella and Peptostreptococcus have been found in endo-perio lesions.  When one suspects the possible endodontic periodontal lesion, the first task is to assess endodontic status of the tooth in question. Traditional diagnostic aids including, radiographic analysis with gutta percha tracing, periodontal probing, fiber optic illumination to rule out whether a fracture exists, more importantly vitality test, percussion tests should be carried out. Numerous studies have demonstrated the inaccuracy of vitality testing. Probably because pulp testing only indicates the neural response and gives little information about the vascularity or true vitality of the pulp. Research is currently under way to improve diagnostic testing through the use of Doppler devices, pulse oximetry and even magnetic resonance imaging. Treatment Treatment some controversy seems to exist, as to whether endodontic therapy or periodontal therapy has to be performed first, in the management of endo-perio lesions. Considering many facts it was advised to perform endodontic therapy prior to periodontal therapy.  When inflammation from pulp extends into the periodontium either through the apical foramen or through the lateral canals destruction of periodontal tissues may occur. This is termed as ‘retrograde periodontitis’. Pathways of communication between pulp and periodon- tium could be of: Developmental origin. Pathologic origin Iatrogenic origin. Endo-perio lesions are classified into: Primary endodontic lesions Primary endodontic with secondary periodontal lesions Primary periodontal lesions Primary periodontal lesion with secondary endodontic involvement. True combined lesions.