Endodontic Periodontal Relations

Palcuto, louvelle lyn Ramos, christienne Raytana, Pamela rose

NO TOOTH IS AN ISLAND

THE EFFECT OF PULPAL DISEASE ON ATTACHMENT APPARATUS

Apical Foramen
pulpal infection resultant bone loss

External resorption of cementum

RESORPTION change the shape and location of the apical foramen.

Lateral Canals
Same response as seen in apical foramen Radiolucent
Notch on the side of the root Untreated canals = Periradicular pathosis and periodontal defects

Dentinal Tubules
Another potential pathway of communication Bydrodynamic theory - mechanism of dentin hypersensitivity Fluid movement stimulates fibers in pulp

Pulpal Death degeneration of odontoblastic process and collagen fibers. Results to :

Increase permeability of the tubules Easy transport of toxin from pulp to attachment apparatus.

 Cementum removal or acid etching of dentin It enhances the ability of bacteria to penetrate the tubules THUS, THE EFFECT OF PULPAL DISEASE ON THE PERIODONTIUM IS A DIRECT INFLAMMATORY ONE.

EFFECT OF ENDODONTIC TREATMENT ON PERIODONTIUM

 The pulpal inflammatory process results in replacement of the periodontal ligament by inflammatory tissue.
Prichard concluded that endodontic obturation of teeth may adversely affect the final result of osseous regenerative procedures.
materials for obturation, the inadequacy of instrumentation obturation, other factors are responsible for failure of such periodontal procedures.

EFFECT OF PERIODONTAL DISEASE ON PULP

 Periodontal disease may extend to the pulp through the accessory canals, the apical foramen, and open dentinal tubules. it does not appear to have a direct inflammatory effect on the pulp The initial effect of periodontal inflammation may be degenerative.
Evident histologically,
an increase in secondary dentin formation, dystrophic calcification, fibrosis, and collagen resorption.

THE EFFECT OF PERIODONTAL TREATMENT ON PULP

 All treatment modalities for periodontal disease have the potential to adversely affect the pulp.

nonsurgical therapy

surgical therapy

Increased hypersensitivity

 Hypersensitivity
caused by
the complete removal of cementum the subsequent exposure of dentinal tubules to the oral environment.

Relieved by
intentional creation of a smear layer application of low-pH solutions

 periodontal soft tissue reattachment therapy

citric acid
two theoretical functions (I) to remove bacterial endotoxin and anaerobic bacteria, and (2) to expose collagen bundles to serve as a matrix for new connective tissue attachment to ccmentum.

 Periodontal surgery affects the pulp to the extent that it is exposed to endotoxin or bacteria via
lateral canals, dentinal tubules, or in extreme cases the apical foramen.

Restorative or Prosthetic Treatment stress and trauma = pulpal necrosis.

DIAGNOSIS

DIAGNOSIS
"combined periodontalpulpal disease if bone resorption (furcation or crestal area) is evident radiographically.

Testing Procedures
A thorough patient history should be obtained Expose a new radiograph. The shape, location, and extension of a bony lesion also inform the diagnosis. Pulp status Look at the soft tissue carefully in order to detect swelling or fistula. Carefully perform periodontal probing

Making the diagnosis of endodontic and periodontic lesions may be difficult, but establishing the correct diagnosis is necessary for devising an appropriate treatment plan and making a prognosis. Ignorance of the signs and symptoms of these disease processes may lead to needless loss of teeth.

Primary Endodontic Lesion

 Sinus tract formation through the periodontal ligament has been shown to be a part of the natural history of pulpal disease.
A sinus tract originating from the apex or a lateral canal may form along the root surface and exit through the gingival sulcus

Discolored incisor with gingival recession

Periapical radiolucency and evidence of periodontal bone disease

 This is not a true periodontal pocket but a fistula that, instead of opening on the buccal or lingual mucosa, drains along the periodontal ligament into the sulcus.

 This drainage through the sulcus often shows as a radiolucency along the mesial or distal root surface or in the bifurcation area

A, Preoperative radiograph with radioluccncy along entire mesial root, giving the appearance of periodontal disease.

B, Nine months after endodontic therapy the mesial bone appears to have remincralized almost completely.

A, Radiograph of lower necrotic bicuspid with periapical and lateral radiolucency. Gutta-percha cone is inserted through gingival sulcus, extending to the apex. B, Recall radiograph demonstrates almost complete healing with endodontic therapy.

A, Preoperative radiograph of lower second molar with furcal radiolucency.. B, Radiograph with periodontal probe into furca extending to the apex of the mesial roots. C, Postoperative radiograph. D, Recall radiograph demonstrates complete furcal healing with endodontic therapy.

A, Lower second molar with periapical radiolucency extending coronally on the distal. B, On postopcralive radiograph, note scaler on lateral root surface.

C, Recall radiograph demonstrates complete healing with endodontic therapy.

 Clinically, drainage may be evident in the sulcus area and some swelling may be present, especially in the bifurcation area, simulating a periodontal abscess.

The tract can usually be probed with a guttapercha or silver cone or a periodontal probe that will go toward the source of irritation, generally the root apex or a lateral canal.

 Pain is not often present, though the patient may have some minor discomfort.

Primary Endodontic Lesion with Secondary Periodontal Disease

 This condition occurs when pulpal disease is long standing and periapical drainage becomes chronic. As the drainage persists through the gingival sulcus, superimposition of plaque and calculus into the pocket results in a periodontal pocket and apical migration of the attachment.

 Resolution of the primary endodontic and the secondary periodontal lesion relies on treatment of both The periodontal bone loss depends on the efficacy of periodontal therapy

Primary Periodontal Lesion

 Pulp of teeth with moderate to severe periodontal disease and no endodontic involvement tests within normal limits Clinically, probing detects broad-based pocket formation and causes bleeding of the tissue

 Examination may also find plaque, calculus, and soft tissue inflammation associated with a purulent exudate

A, A molar has an apparent periapical lesion.

B, Postoperative radiograph.

C, Low-power view of a section of vital pulp extirpated from this molar.

D, High power photomicrograph shows vital pulp tissue with calcification.

A, A lower first molar with furcal and distal radiolucency, large MOD restoration, and recurrent M and D decay.

B, Gutta-percha probe to the apex of the distal root. Pulp testing results were within normal limits.
C, Diagnosis of periodontal periodontitis lesion. Note calculus on the root surface. D, Tooth fractured to reveal vital pulp tissue, confirming diagnosis of periodontitis.

 Traumatic occlusion may be the cause of an isolated periodontal problem. Treatment depends on the extent of the periodontal disease and on the patient's ability to comply with possible long-term treatment and maintenance therapy
Because the pulps of these teeth test within normal limits the prognosis depends on the outcome of periodontal therapy.