Colleagues for excellence 4 condensing osteitis is a diffuse radiopaque lesion representing a localized bony reaction to a lowgrade inlammatory stimulus usually seen at the apex of the tooth. And the missing patterns of endo perio lesions were identified, and then. This article is from journal of clinical and experimental dentistry, volume 6. These lesions are primarily caused by periodontalpathogens.
In this report, we present several treatment modalities in. The complexity of endo perio lesions reflects the relevance of a close developmental. The author discusses the different origins of endo perio lesions and the importance of diagnosing the source of the lesion to allow appropriate. This is achievable by careful history taking, examination and the use of special tests. Differential diagnosis of endo perio lesions 16 primary endodontic disease. The subject of combined endo perio lesions is surrounded by considerable confusion. As you can we have a diagnostic dilemma, if the perio endo lesion has advanced to the point that the pulp is nonvital. A symptomatic tooth may have pain of periodontal andor pulpal origin. Endoperio lesions are occasionally encountered complicated dental conditions, difficult to diagnose and treat. One of the main classification items was primary endodontic disease.
Pdf etiology and classification of endodonticperiodontal lesions. Introduction primary pulpal infection leading to periradicular periodontitis both infections occur simultaneously as independent perio and endo lesions primary periodontal infection causing breakdown of alveolar crestal bone, leading all the way to apex the two infections coalesce to. Bettina basrani and a team of prestigious international contributors build upon traditional radiographic techniques and include the latest information available on digital radiographs and cone beam computed tomography. A perio endo lesion can have a varied pathogenesis which ranges from quite simple to relatively complex one. From the diagnostic point of view, it is important to realize that as long as the pulp remains vital, although inflamed. An essential primer to clarify diagnosis and treatment of endoperiodontal lesions. The nature of that pain is often the first clue in determining the etiology of such a problem. It is possible for an acute exacerbation of a chronic periapical lesion on a tooth with a necrotic pulp to drain through the pdl into the. Etiologic factors such as bacteria, fungi, and viruses as well as various contributing factors such as trauma, root resorptions, perforations, and dental malformations play an important role in the development and progression of such lesions. The prognosis for successful management is highly dependent on proper initial classification and subsequent sequencing of treatment. A new classification of endodonticperiodontal lesions khalid s. Abstractpulpal and periodontal problems are responsible for more than half of the.
An endo perio lesion is one of the most common problems encountered in the day today practice. The prognosis and treatment of each endodontic periodontal. These endodontic lesions are compared with primary periodontal lesions and primary periodontal lesions with secondary endodontic participation. Endodontic periodontal combined lesion is a clinical dilemma because making a differential diagnosis and deciding a prognosis are difficult. Divya bhat abstract an endo perio lesion has been one of the most common problems associated with the tooth. Endodontic periodontal diseases often present great challenges to the clinician in their diagnosis, management, and prognosis. Singlerooted teeth have a less favorable prognosis than multirooted teeth because the latter can undergo root resection as an alternative treatment. Differentiating between a periodontal and an endodontic problem can be difficult. Endoperio lesions primarily occur by way of the intimate anatomic and vascular connections between the pulp and the periodontium. Successful management of teeth with different types of. A diagram that summarises lesion development the relationships between them. Pdf endodonticperiodontal lesions occur as a combination of an endodontic infection and periodontal disease in. Based on these classifications, the most widely used classification of endodontic periodontal lesions is the one that has been classified by simon et al.
How to diagnose and treat periodontal endodontic lesions. The prognosis for a tooth with periodontal disease is determined by the result of the periodontal therapy. There does not seem to be a direct association between the local humoral immune response and cultivable microflora in the endodontic periodontic lesion, a situ ation similar to. Syed wali peeran, madhumala thiruneervannan, khaled awidat abdalla, marei hamed mugrabi. A retrospective study of blomlof concluded that the endodontic infection promotes periodontal pocket formation and is a risk factor in the progression of periodontitis, so, a primary endodontic lesion draining through the attachment apparatus should be initially treated by an endodontic treatment, since an aggressive removal of the periodontal ligament and cementum. Typically, endodontic lesions resorb bone apically and laterally and destroy the attachment apparatus adjacent to a nonvital tooth. In most cases, pulp tests indicate a clinically normal pulpalreaction. Whereas the endo perio lesion will often produce resolution of the joint problem with endodontic treatment alone, the perio endo lesion will still require periodontal treatment and even then the prognosis is far poorer. Jffa aza syd page 2 pulpoperiodontal problems perio endo lesion periodontitis by extension of inflammation from the gingiva into deeper periodontal tissues. Pdf periodontal aspects of endodonticperiodontal lesions. For differential diagnosis and treatment purposes, endo perio lesions are classified as either. Unlimited viewing of the articlechapter pdf and any associated supplements and figures.
This work is to discuss the management of an endo perio lesion, which represents a challenge to clinicians when it comes to diagnosis and prognosis of the involved teeth and especially with an altered general condition. If we were to look at endoperio lesions that began from the endodontic tissue, there are a number of potential causes. The tooth with endo perio lesions should be evaluated thoroughly in terms of any cracks. Management of endodonticperiodontic lesions springerlink. This case report evaluates the prognosis of endo perio lesion which was first treated with conventional endodontic therapy and then followed by periodontal. Endodontic periodontal lesions present challenges to the clinician as far as diagnosis and prognosis of the involved teeth are concerned.
Combined periodontic endodontic lesions take the form of abscesses and can originate from either or both of two distinct locations and may be informally subclassified as follows. Endo perio lesions are a common finding in the dental practice. The book opens by addressing the etiology and classification of endodonticperiodontal lesions, and demonstrates its relevance to the daily practice. Endodonticperiodontal lesions pdf this book presents a multidisciplinary evidencebased approach to the management of teeth with lesions of endodontic periodontal origin.
A microbiological and immunological study of endodontic. One frequently hears diagnoses of endo perio lesions when in fact there is an endodontic lesion mimicking periodontal disease or, vice versa, a purely periodontal lesion perfectly is camouflaged as an endodontic pathology. The success of management of a combined periodontal and endodontic lesion depends on the elimination of both of the disease processes. Understanding the disease process through causeandeffect relationships between the pulp and supporting periodontal tissues with the aid of rational classifications leads to successful treatment outcomes. Endodontic radiology, 2nd edition, is a unique reference that examines all aspects of radiographic imaging related to endodontics. Abundant case documentation illustrates the close connection between the dental pulp and the periodontium and shows the variety of clinical situations in which this dualnatured pathology can present. In this case report, different kinds of endo perio lesion were treated with sequential endodontic and periodontal treatment. A sequential approach in treatment of endoperio lesion a.
Pdf endoperio lesions are occasionally encountered complicated dental conditions, difficult to diagnose and treat. The simultaneous involvement of pulpal problems along. In this report the pulp vitality test which showed the nonvital nature of the tooth was a pivoting finding suggesting the primary endodontic involvement. Endo perio lesion a case report journal of medical biomedical. The simultaneous involvement of pulpal problems and inflammatory periodontal disease can complicate. Lesions of the periodontal ligament and adjacent alveolar bone may originate from infections of the periodontium or tissues of the dental pulp. A practical way to classify endo perio lesions for treatment planning purposes is to separate into three broad categories.
The followup radiographs showed complete healing of the hard and soft tissue lesions. Pdf a new classification of endodonticperiodontal lesions. Endodontic periodontal relationship, endo perio lesion. A 50yearold female patient with uncontrolled diabetes type 2 is suffering from a purulent discharge coming from the upper right canine. Differentiating between periodontal and endodontic problems can be difficult. Endodontic periodontal lesions are complicated disease entity, frequently encountered in daytoday dental practice, difficult to diagnose and treat. Generally, in a case of combined endo perio lesion, an adequate endodontic therapy would. Knowledge of these disease processes is essential in coming to the correct diagnosis.
An endo perio lesion can have a varied pathogenesis which ranges from simple to relatively complex one. A new classification of endodonticperiodontal lesions. Cases with endodontic periodontal lesions usually present with several clinical and radiological features, such as altered response to testing of pulp sensitivity, clinical signs of gingival inflammation, increased probing pocket depth, sinus tracts, pus secretion and different types of radiological bony defects, several areas of the dentition show periodontal involvement, all of which. The results support the suggestion that the source of endodontic infection in endodontic periodontic lesions of primary periodontal etiology is the periodontal pocket. Specific endodontic, prosthetic, and periodontal considerations that should be incorporated into clinical decision making and treatment planning are then discussed in detail. The interrelationship between periodontal and endodontic disease has always aroused confusion, queries, and controversy. The initial task of treating endodontic periodontal. A case series associated with different kinds of endo. A symptomatic tooth may have pain of periodontal andor pulpal.
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