🌟 PERIO-ENDO RELATIONSHIP
📌 POINTS TO PONDER
🔹Periodontal probing, pulp vitality test and radiographs are the cornerstones for diagnosis and classifying endo-perio lesions.
🔹When fistula with gutta percha point is traced to radiograph apex, then endodontic etiology can be considered.
🔹When fistula with gutta percha point is traced to midroot, then periodontal etiology/ pulpal necrosis in lateral canal can be considered.
🔹A long, narrow pocket in a single tooth in a mouth generally free from periodontal disease is usually associated with primary pulpal disease.
🔹A pocket that does not extend to the apical one third of the root in a periodontally diseased mouth indicates primary periodontal origin.
📣 Treatment And Prognosis Of Periodontal-Endodontic Lesions
💠 Primary Endodontic Lesion:
🔸Treatment – Root canal treatment
🔸Prognosis – Good
💠 Primary Periodontal Lesion:
🔸Treatment – Periodontal treatment
🔸Prognosis – Depends upon periodontal treatment and patient’s response
💠 Primary Endodontic-Secondary Periodontal Lesion:
🔸Treatment : Root canal treatment first followed by periodontal treatment after 2-3 months
🔸Prognosis : Depends upon endodontic and periodontal treatment and patient’s response
💠 Primary Periodontal-Secondary Endodontic Lesion:
🔸Treatment – Endodontic and periodontal treatment (GTR)
🔸Prognosis – Depends upon severity of the periodontal disease and periodontal tissue response to treatment
💠 True Combined lesion:
🔸Treatment – Endodontic and periodontal treatment procedures including surgical procedures like amputation, hemisection or bicuspidization
🔸Prognosis – More guarded prognosis
📌 VIVA VOCE
Q1. What are various anatomical pathways of communication between pulpal and periodontal tissue?
Ans. Apical foramen, accessory canals/ lateral canals, dentinal tubules and palatogingival grooves.
Q2. What are various non- anatomical/ non-physiological pathways of communication between pulpal and periodontal tissue?
Ans. Root canal perforations and traumatic vertical root fractures.
Q3. What is retrograde periodontitis?
Ans. Retrograde periodontitis is long-standing periapical lesion which drains through the periodontal ligament.
Q4. What is retrograde pulpitis?
Ans. Bacterial and inflammatory products of periodontitis can access the pulp via apical foramen, lateral canals, accessory canals, and dentinal tubules and this reverse effect is called as retrograde pulpitis.
Q5. What is the basic difference in the pocket configuration of primary periodontal lesion and primary endodontic lesion?
Ans.
🔸Pocket with broad configuration is suggestive of primarily periodontal lesion.
🔸Pocket with narrow configuration/ tube like pocket is suggestive of primarily endodontic lesion.
Q6. Which is the main and direct communication route between the pulp and periodontium?
Ans. Apical foramen.
Q7. What is true combined lesion?
Ans. Lesion which occurs due to coronal progression of endodontic lesion, which joins with infected periodontal pocket progressing apically.
Q8. How primary endodontic lesion is treated?
Ans. By Root canal treatment.
Q9. How primary endodontic with secondary periodontal lesion is treated?
Ans. Root canal treatment first followed by periodontal treatment after 2–3 months.
Q10. What are the cornerstones for diagnosis and classifying endo-perio lesions?
Ans. Periodontal probing, pulp vitality test and radiographs.
📌 MCQs
💡Following are the various developmental pulpal-periodontal communications except:
A. Dentinal tubules
B. Lateral canals
C. Apical foramina
D. Developmental grooves
E. CEJ
Answer : E
💡Iatrogenic causes of Perio – Endo lesions are:
A. Root perforation
B. Vertical root fractures
C. None of the above
D. Both A and B
Answer : D
💡Retrograde periodontitis is:
A. Long – standing periapical lesion draining through the periodontal ligament
B. The apical progression of a periodontal pocket to reach apical tissues and pulp via accessory canals, apical foramen
C. Both A and B
D. None of the above
Answer : A