endodontic – periodontal relations

7/29/2019 Endodontic Periodontal Relations

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Endodontic PeriodontalRelationsPalcuto, louvelle lyn

Ramos, christienneRaytana, Pamela rose


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NO TOOTH IS AN

ISLAND


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THE EFFECT OF PULPAL DISEASE

ON ATTACHMENT APPARATUS


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Apical Foramen

pulpal infection resultant bone loss

External resorption of cementum

RESORPTION change the shape and location ofthe apical foramen.


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Lateral Canals

Same response as seen in apical foramen

Radiolucent

Notch on the side of the root

Untreated canals = Periradicular pathosis and

periodontal defects


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Dentinal Tubules

Another potential pathway of communication

Bydrodynamic theory - mechanism of dentinhypersensitivity

Fluid movement stimulates fibers in pulp


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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.


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Cementum removal or acid etching of dentin

It enhances the ability of bacteria to penetrate thetubules

THUS, THE EFFECT OF PULPAL DISEASE ON THEPERIODONTIUM IS A DIRECT INFLAMMATORY

ONE.


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EFFECT OF ENDODONTIC

TREATMENT ON PERIODONTIUM


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The pulpal inflammatory process results in

replacement of the periodontal ligament by

inflammatory tissue.

Prichard concluded that endodontic

obturation of teeth may adversely affect thefinal result of osseous regenerative

procedures.

materials for obturation, the inadequacy of instrumentation

obturation,

other factors are responsible for failure of such

periodontal procedures.


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EFFECT OF PERIODONTAL DISEASE

ON PULP


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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 inflammationmay be degenerative.

Evident histologically,

an increase in secondary dentin formation, dystrophic calcification,

fibrosis, and collagen resorption.


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THE EFFECT OF PERIODONTAL

TREATMENT ON PULP


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All treatment modalities for periodontal

disease have the potential to adversely affect

the pulp.

nonsurgical therapy surgical therapy

Increased hypersensitivity


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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


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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.


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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.


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DIAGNOSIS


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DIAGNOSIS

"combined periodontalpulpal disease

if bone resorption (furcation or crestal

area) is evident radiographically.


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Testing Procedures

A thorough patient history should be obtained

Expose a new radiograph.

The shape, location, and extension of a bonylesion also inform the diagnosis.

Pulp status

Look at the soft tissue carefully in order todetect swelling or fistula.

Carefully perform periodontal probing


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Making the diagnosis of endodontic andperiodontic lesions may be difficult, but

establishing the correct diagnosis is

necessary for devising an appropriatetreatment plan and making a prognosis.

Ignorance of the signs and symptoms of

these disease processes may lead toneedless loss of teeth.


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Primary Endodontic Lesion


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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 alateral canal

may form along the root surface and exit

through the gingival sulcus


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Discolored incisor with gingival

recession

Periapical radiolucency and

evidence of periodontal bone disease


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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.


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This drainage through the sulcus often shows

as a radiolucency

along the mesial or distal root surface or inthe bifurcation area

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

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


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A, Radiograph of lower necrotic bicuspid with periapical andlateral radiolucency. Gutta-percha cone is inserted throughgingival sulcus, extending to the apex.

B, Recallradiograph demonstrates almost complete healing withendodontic therapy.


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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.


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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.


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Clinically, drainage may be evident in the

sulcus area and some swelling may bepresent, especially in the bifurcation area,

simulating a periodontal abscess.

The tract can usually be probed with a gutta-

percha or silver cone or a periodontal probe

that will go toward the source of irritation,generally the root apex or a lateral canal.


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Pain is not often present, though the patient

may have some minor discomfort.


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Primary Endodontic Lesion with

SecondaryPeriodontal Disease


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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.


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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


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Primary Periodontal Lesion


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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


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Examination may also find plaque, calculus,

and soft tissue inflammation associated with a

purulent exudate


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A, A molar has an apparent periapicallesion.

B, Postoperative radiograph.

C, Low-power view of a section of

vital pulp extirpated from this molar.

D, High power photomicrographshows vital pulp tissue with

calcification.


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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 th

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, confirmingdiagnosis of periodontitis.


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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-termtreatment and maintenance therapy

Because the pulps of these teeth test withinnormal limits the prognosis depends on the

outcome of periodontal therapy.

endodontic – periodontal relations

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