Beruflich Dokumente
Kultur Dokumente
LESIONS
Submitted by,
SWETHA SUSAN JACOB
Final year Part-A
CONTENTS
. Introduction
. Microbiology
. Causes
. Pathways of communication
. Classification
. Diagnosis
. Treatment
. Conclusion
. Reference
INTRODUCTION
• The tooth and periodontium are closely related
and diseases of one tissue may lead to secondary
disease in the other.
• Differential diagnosis of endodontic and
periodontal diseases is of vital importance to make
a correct diagnosis.
• In Pulpo-periodontal lesion, pulpal necrosis
precedes periodontal changes. A periapical lesion
originating in pulpal inflammation and necrosis
may drain to the oral cavity through PDL and
adjacent alveolar bone.
MICROBIOLOGY
• Periodontal disease and pulpal infection are
polymicrobial process and is often anaerobic
in nature.
Organisms are
T.forsythus, T.denticola, P.gingivalis,
F.nucleatum, spirochetes,
Peptostreptococus.
CAUSES
1.Root anatomy :
presence of additional canal in teeth
large no: of accessory canals
2.Root pathology : Root resorption
Root perforation
3.Root fillings : Overfilling root canals
Intracanal medicaments
4.Trauma : Crown fracture
Vertical root fracture
Malpositioned teeth
Combined with gingival inflammation
PATHWAYS OF COMMUNICATION BETWEEN
PULP & PERIODONTIUM
• Developmental origin :
a) Apical foramen
b) Developmental grooves
c) Accessory canals & Lateral canals
d) Enamel projections & pearls
• Pathologic origin :
a) Tooth fracture
b) Idiopathic root resorption
c) Loss of cementum due to external irritants
PATHWAYS OF COMMUNICATION ….
• Iatrogenic origin
• Perforations
• Root fractures
• Sodium hypochlorite accident
• Improper use of ultrasonic device
CLASSIFICATION
DIAGNOSIS
Patient asymptomatic with history of acute
exacerbation
Necrotic pulp draining through PDL into gingival
sulcus
Isolated pockets on side of tooth with minimal plaque
& calculus
PRIMARY ENDODONTIC LESION WITH
SECONDARY PERIODONTAL INVOLVEMENT-
RETROGRADE PERIODONTITIS
ETIOLOGY
RADIOGRAPHIC FEATURES
Periapical radiolucency
Some resorption of crestal alveolar bone
DIAGNOSIS
Continuous irritation of
periodontium from necrotic pulp or
from failed RCT
Isolated deep pockets
Periodontal breakdown in the
pocket
PRIMARY PERIODONTAL LESION
ETIOLOGY
ETIOLOGY
RADIOGRAFIC FEATURES
Bone resorption more extensive
DIAGNOSIS
Generalized periodontal disease
Non-vital tooth
Mobile tooth
Pocket may show discharge on
palpation
TRUE COMBINED LESION
ETIOLOGY
A periodontal infection coalescence with a
periapical lesion of pulpal origin
CLINICAL FEATURES
Conical type of probing
At the base of the periodontal lesion the probe abruptly
drops further down the root surfaces & may extend the
tooth apex
RADIOGRAPHIC FEATURES