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Endo perio seminar
- 20. Periodontal disease isnow thought by most researchers to be caused by a mixed anaerobic infection, modulated by a complex interplay with local and host factors. Pulpal infection is a polymicrobial process & is of an anerobic nature. As the infective process proceedes, the proportion of strict anaerobic-to-facultative organisms & the total number of bacteria increases. An exception to this rule seems to be the microaerophilic A. actinomycetemcomitans, which has been associated with aggressive periodontitis (Newman & Socransky 1977).
- 23. Most of the species that have been found in infected root canals can also be present in the periodontal pocket. (Moore 1987, Sundqvist 1994) Porphyromonas endodontalis seems to be very rare in oral infections other than those of endodontic origin. (VanWinkelhoff et al. 1988) Overall, the root canal flora does not appear to be as complex as the periodontal flora of adjacent pockets. However, it is inherent problems in bacterial sampling of periodontal pockets that strains from more shallow levels of the site are harvested along with the strains at the front of the lesion.
- 32. Necrosis of thepulp, however, can result in bone resorption and the production of radiolucency at the apex of the tooth, in the furcation or at points along the root. The lesion that results may be: an acute apical lesion or abscess, a more chronic peri-radicular lesion (cyst or granuloma) or a lesion associated with a lateral or accessory canal. The lesion may remain small, or it can expand sufficiently to destroy a substantial amount of the attachment of the tooth and/or to communicate with a lesion of periodontitis.
- 35. Different authors havecreated varying nomenclatures for these pathologies, based on either etiological or clinical criteria, or a combination of these factors. Simon et al. (1972) separated the lesions of both periodontal and pulpal tissues into the following groups: Primary endodontic lesions with secondary periodontal involvement, Primary periodontal lesions with secondary endodontic involvement, and True combined lesions.
- 41. Appropriate endodontic therapyis sufficient to result in healing of the lesion. Occasionally an abscess of pulpal origin, through an apical or lateral canal, may establish drainage through the periodontal ligament & erupt into the furcation or the gingival sulcus.
- 43. (A)Preoperative radiograph showing large periradicular radiolucency associated with the distal root and furcal-lucency. (B)Clinically, a deep narrow buccal periodontal defect can be probed. Note gingival swelling. (C)One year following root canal therapy, resolution of the periradicular bony radiolucency is evident. (D)Clinically, the buccal defect healed and probing is normal.
- 44. Chronic periodontitis progressesapically along the root surface. In most cases, pulp tests indicate a clinically normal pulpal reaction. The prognosis depends upon the stage of periodontal disease and the efficacy of periodontal treatment.
- 46. The progress ofperiodontitis is slow. The involvement of apical periodontium by the pulpal lesion may obscure the symptoms of the periodontium. Because the apical lesion tends to be the most painful lesion, endodontic therapy is normally initiated first. Endodontic therapy results in the resolution of the endodontic lesion , but has little or no effect on the periodontal pocket, an appropriate periodontal therapy is required for a successful result.
- 47. Such lesions maypresent with the characteristic of both diseases, which may complicate diagnosis & treatment planning. The extent to which the periodontal lesion contributes to the loss of bone is a key consideration in diagnosis & treatment planning
- 51. (A) Preoperative radiographshowing periradicular radiolucencies. Pulp sensitivity tests were negative. (B) Immediate postoperative radiograph of nonsurgical endodontic treatment. (C) Six-month follow-up radiograph showing no healing. Gutta-percha cone is inserted in the buccal gingival sulcus. (D) Clinical photograph showing treatment of the root surfaces and removal of the periradicular lesion. (E) One-year follow-up radiograph demonstrating healing.