DR.

ADIL IQBAL BDS House Surgeon Hamdard Hniversity Hental Hospital Karachi, Pakistan

Aim OF PRESENTATION: Discuss relation between endodontic and periodontic diseases. Biological and clinical evidence of diagnosis Decision making in the treatment

Dentinal tubules Lateral and accessory canals Apical foramen

minimal inflammatory response..extensive destruction. Sinus tract irrigants ,sealers and ICM may extrude from canal to periodontium..

TWO schools of thaught: 1)no major effect 2)effect is degenerative causing increase in calcification, fibrosis, and direct inflammatory sequlae. Periodontitis patients are threefold times more prone. Accessory and lateral canals if present then more chances

Perio lesion

Primary endodontic Primary periodontal Primary endodontic with secondray periodontal Primary periodontal with secondrary endodontic True combined

Deep solitary pocket in absence of periodontal disease Drainage thru PDL to gingival sulcus Diagnosisradiograph with GP Radiographically wide PDL space and periapical radiolucency Pulp test abnormal or absent Narrow pocket Prognosisusually heal after RCT.

Clinically chronic marginal periodontitis, plaque accumulation and deposits of plaque and calculus. Wider pockets Bony lesions associated with angular bone loss extending from cervical lesion towards the apex. Lesion also involves adjacent tooth Normal pulp test. Wider pockets Prognosis on stage of periodontic diease.

A primary perio lesion wrongly diagnosed and treated as endo lesion. Treatment was failure and tooth lost.

No treatment of primary endodontic disease for long period of time Clear widening of pdl space extending from apical to cervical. Pulp test is usually absence of response. On probing solitary wider pocket extending toward the apex. Both endodontic and periodontal treatments required and prognosis depends on severity of marginal periodontal damage and efficacy of periodontal treatments.

Chronic marginal periodontitis Radiographically bone loss from cervical region towards the apex and usually not limitted to just single tooth. Apical radiolucency Symptoms of pain inflammed pulp at early stage but later on pulp becomes unresponsive. Poor prognosis in single rooted teeth.

Lesion present on both sides May or may not join depending on stage of disease Extensive radiolucencies of both origin Unresponsive pulp Wider pockets Prognosis is usually guarded. Longitudinal root fractures mimic the same radiographic picture