Pulpal and periodontal problems are responsible for more than 50% of tooth mortality today. An endo-perio lesion can have a varied. An endo-perio lesion can have a varied pathogenesis which ranges from simple to relatively complex one. The differential diagnosis of. 10 steps to efficient endo in the general practice. For differential diagnosis and treatment purposes, “endo-perio” lesions are classified as either.

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A periapical lesion may perforate the cortical bone close to the apex, elevate the periosteum and overlying soft tissues, and drain into the gingival sulcus, 36 and form pseudopockets that simulate periodontal disease without necessarily permanent damaging of the cementum and its fibres.

International Journal of Dentistry

Progression of the periodontal disease and the pocket leads to pulpal involvement via either a lateral canal foramen or lrsion main apical foramen. Primary endodontic lesions with secondary periodontal involvement may also occur as a result of root perforation during root canal treatment, or where pins or posts have been misplaced during lewion restoration.

A histologic evaluation of dental pulp tissue nedo a patient with periodontal disease. The artificial pathways between periodontal and pulpal tissues are vertical root fractures. There is a general agreement today that the vast majority of pulpal and periodontal lesions are the result of bacterial infection. The pathogenesis and treatment of endo-perio lesions. Endodontic-periodontal lesions present challenges to the clinician as far as diagnosis and prognosis of the involved teeth are concerned.

There are four types of perio-endo lesions and they are classified due to their pathogenesis. However, primary endodontic disease with secondary periodontal involvement, primary periodontal disease with secondary endodontic involvement, or true combined diseases are clinically and radiographically very similar.


Carious lesions or any direct exposure to the oral cavity of dentine or pulp may ingress bacteria to contaminate an otherwise sterile lesion. Clin Oral Investig ;4: Int Endod J ; Etiologic factors such as bacteria, fungi, and viruses as well as other various contributing factors such as trauma, root resorptions, perforations, and dental malformations also play an important role in the development and progression of such lesions.

Clinical applications, drawbacks, and mechanism of action. The pulp may remain vital but may show some degenerative changes over time. Treating primary periodontal lesions Determining the prognosis depends upon the stage of periodontal disease and the efficacy of periodontal treatment.

This makes it difficult to diagnose because a single lesion may present signs of both endodontic and periodontal involvement. They concluded that pathogens in necrotic root canals may stimulate epithelial downgrowth along denuded dentin surfaces with marginal communication and thus augment periodontal disease.

Endo-Perio Dilemma: A Brief Review

lesuon Although there is existence of these communication routes, the mechanism of direct transmission of the periodontal infection to the pulp is still controversial. Diagnosis, prognosis and decision-making in the treatment of combined periodontal-endodontic lesions.

Widening of the periodontal ligament along one or both sides of the root, or bone loss in solitary tooth are the major radiographic findings. The use of guided tissue regeneration principles in endodontic surgery for induced chronic periodontic-endodontic lesions: It is formed when a coronally progressing endodontic disease joins an infected periodontal pocket progressing apically.


A New Classification of Endodontic-Periodontal Lesions

It is known that both the pulp and the periodontium are closely linked to each other, through the apical foramen, accessory canals, and dentinal tubules of the root, and one can interfere on the integrity of the other.

Endodontic complications following periodontal and prosthetic treatment of patients with advanced periodontal disease. A histologic evaluation of periodontal tissues adjacent to root perforations filled with Cavit. Endodontic treatment of experimental root perforations in dog teeth. Introduction The endodontium and periodontium are closely related and diseases of one tissue may lead to the involvement of the other.

A survey of cases in Chinese patients. Madison S, Wilcox LR. Some authors such as Rubach and Mitchell [ 18 ] affirmed that the periodontal disease may affect the pulp when there is exposure of the accessory canals through the apical foramina and the canaliculi in the furcation.

The effect of periodontal disease on the pulp. Calcium ion diffusion from calcium hydroxide-containing materials in endodontically-treated teeth: Torabinejad M, Kiger RD.

In some cases, the influence of pulpal pathology may cause the periodontal involvement and vice versa. It has been recognized that the success of the treatment depends mainly on immediate sealing of the perforation and appropriate infection lezion. Int J Periodontics Restorative Dent ; External resorption associated with bleaching of pulpless teeth.

A clinical retrospective study. The tooth anatomy and the etiology of endodontic-periodontal lesions offer a strong base for establishing a correct diagnosis.