Endodontic-Periodontic Relationships Pulpal inflammation can result from exposure of lateral canals

Donna Mattscheck D.M.D

Diplomate, American Board of Endodontics Pulpal necrosis results only when the main apical foramen is invaded by bacteria
Division of Endodontics Langeland, et al.OOO 1974;34:357
University of Minnesota
Effect of Pulpal Disease on Periodontal Treatment
Perio treatment of teeth with pulpal necrosis and PARL resulted in retarded or impaired
The Pulpal and Periodontal structures have a similar and inter-related embryologic perio healing
development. Ehnevid et al. J Periodontal, 1993;64:1199

DIAGNOSIS of ENDODONTIC - PERIODONTICLESIONS

Pulpal -
Apical Foramina History
Lateral Canals
Endodontic Lesions
Dentinal Tubules
Generally, endodontic lesions are associated with necrotic pulps having a distinct
Evaluated 1,140 teeth for accessory canals etiology for pathosis.
27.4% exhibited accessory canals Caries Attrition
Restorations Abrasion
Middle third 8.8% Cracks Erosion
Coronal third 1.6% Trauma Orthodontics
DeDeus, J Endodon 1975;1:361

Evaluated 102 teeth for accessory canals in the furcation and furcal region Periodontal Lesions
Furcal 25.5% Local Factors
Gutmann JL, J Periodontol 1978;1:21-6
Plaque Bleeding
Calculus Exudation
Bacterial infection of the pulp system has great propensity to induce a significant Staining Pocket Formation
inflammatory and immune response in the periradicular tissues. Whereas bacterial
infection of the periodontal tissues has a minimal effect on pulpal tisssues.
Endodontic Lesions
Narrow coronally
Effect of Periodontal Disease on Pulpal Pathosis Isolated to the involved tooth
Pocket depth
Bone loss Periodontic Lesions:
Extent of periodontal disease Not isolated to one specific tooth
Pulpal involvement Wide coronally

Bender and Seltzer. OOO 1972;33:958 Classification of Endodontic-Periodontic Lesions

Mazur and Massler, 1964 Primary Endo
Czarnecki and Schilder. JOE 1979; 5:242 Primary Perio
Torabinejad and Kiger. OOO 1985;59:198 Primary Endo w/ Secondary Perio
Langeland et al. OOO 1974;37:257 Primary Perio w/ Secondary Endo
True Combined
Concomitant Pulpal-Periodontal PRIMARY PERIO - SECONDARY ENDO
Two separate and distinct entities Is characterized by a necrotic pulp
Osseous destruction exposes
dentinal tubules
Lateral, accessory, and furcation canals
EndodonticLesions: The apical foramina
Endodontic Treatment Major etiology
Heals by regeneration periodontal disease and/or it’s treatment

Periodontic Lesions: TRUE COMBINED LESION

Periodontal Therapy An endodontic lesion merges with a periodontal pocket
Heals by reattachment Developmental Defects
Resorptive Defects
Root Fractures
THE ENDODONTIC LESION Perforations
Necrotic pulp
May exhibit an isolated periodontal defect
-pulpal necrosis does not cause periodontal disease. It may, however, cause formation of Palato-Gingival Groove Defects
a sinus tract through the periodontal ligament Kogan, S., J Periodontol 1986; 27:231
Osseous destruction is localized to the involved tooth Indicated an incidence of 4.6% in maxillary centrals and laterals
The healing process involves regeneration of periodontal and osseous structures 43% of the grooves extended less than 5 millimeters
47% extended 6 to 10 millimeters
10% extended more than 10 millimeters
THE PERIODONTIC LESION
Is characterized by a vital pulp Palato-Gingival Groove Defects Anderegg, C.R., and Metzler, D.G.
The patient usually exhibits generalized bone loss J Periodontaol 1993; 64:72-74
Local factors are present 10 cases
The healing process generally involves reattachment Maxillary lateral incisors
Flap reflection, scaling and root planning of the groove, and placement of
polytetrafluoroethylene membrane over the groove
PRIMARY ENDO - SECONDARY PERIO Results indicated an improvement of attachment, a decrease in probing depths, and a
Is characterized by a necrotic pulp decrease in bleeding on probing at six months post surgery
The endodontic condition has caused a periodontal communication
Endodontic therapy is initiated and the result determines if periodontal therapy should be Root Amputations /Hemisections
initiated Langer, et al.J Periodontol 1981;52:719
Evaluated 100 cases of root resections at ten years. There were 38 failures.
84% of the failures occurred after five years
Hiatt 47% of the failures were attributed to fracture of the remaining root or roots
J Periodontol 1977; 48:598
When you are unable to establish a diagnosis, consider the lesion to be of pulpal origin, Root Amputations/Hemisections
as endodontic treatment may correct both lesions Buhler, J Periodontol 1988;59:805
28 cases of root resections
10 years
ENDODONTIC-PERIODONTIC LESIONS 32% failure rate
Endodontic treatment should always be completed prior to periodontal therapy
The periodontal condition generally dictates the overall prognosis