Endodontic periodontal diseases often present great challenges to the clinician in their diagnosis, management, and prognosis. An endo perio lesion can have a varied pathogenesis which ranges from simple to relatively complex one. Endo perio abscess gingival abscess periodontal abscess out of the scope part 3. Treatment using both surgery and antibiotics resulted in extensive healing without any concommitant endodontic therapy. The diagnosis was a primary endodontic lesion with secondary periodontal involvement. Fistula bolsa perio lesion pulpar periodonto substituido por conectivo inflamatorio tejido no. 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. Introduction e periodontal endodontic lesions have been characterized by the involvement of the pulp and periodontal disease in thesametooth. The aim of this study is to emphasise that primary endodontic lesion heals after a proper instrumentation, disinfection and sealing of the endodontic space. The results suggest that lesions affecting the apical periodontium are either periodontal or pulpal in origin.
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. In this case report, different kinds of endo perio lesion were treated with sequential endodontic and periodontal treatment. Treatment of endoperiodontal lesion using leukocyteplateletrich fibrin. The case involves a 10yearold male patient with pulpal necrosis and apical periodontitis of tooth 46. In this case, following endodontic treatment the periodontal lesion did reduce to an. The present case report shows the importance of periodontal therapy that includes open debridement of the defect followed by placement of alloplastic bone graft gbone. Treatment of type iii periodontalendodontic lesion combined or true. Endodontic periodontal combined lesion is a true challenge. Figura 3 abhishck parolia, toh choo gait, isabel c.
Successful management of teeth with different types of. Her general dentist and 2 other specialists were unwilling to treat this tooth due to the the perceived hopeless prognosis of the case. The simultaneous involvement of pulpal problems and inflammatory periodontal disease can complicate. The subject of combined endo perio lesions is surrounded by considerable confusion. A case series associated with different kinds of endo. An endo perio lesion has been one of the most common problems associated with the tooth. Endo perio lesions might be interdependent because of the vascular and anatomic connections between the pulp and the periodontium. The longterm prognosis after t reatment of perio endo lesions is determined by correct prima ry diagnosis and careful endodontic treatment, followed by periodontal treatment. Endo perio lesion always poses a cha llenge to the cl inician for correct diagnosis and treatment planning. Both endodontic and periodontal diseases are caused by a mixed anaerobic infection. The main objective of this paper was to report the clinical effectiveness of leukocyte platelet rich fibrin lprf in the treatment of a combined endo periodontal lesion of an.
A sequential approach in treatment of endoperio lesion a. Abstract a series of cases demonstrating the destruction of periapical periodontal structures, without pulpal involvement has been presented. Anatomic considerations of the pulpal and periodontal continuum. Different perspectives in understanding the pulp and periodontal intercommunications with a new proposed classification for endoperio lesions. Endodontic periodontal combined lesion is a clinical dilemma because, arriving at a differential diagnosis and deciding a prognosis is difficult. In this report, we present several treatment modalities in.
The true combined endodontic and periodontic lesion requires an accurate diagnosis. Kim et al 11 reported that even with the aid of a microscope, the treatment success of the endodontic periodontal combined lesion remained. A 42yearold woman with an abscess, deep periodontal pockets, and nonvital teeth was treated using a multidisciplinary approach. Divya bhat abstract an endo perio lesion has been one of the most common problems associated with the tooth. World workshop, endoperio lesions, periodontitis, gingival recession, queratinized gingiva, trauma from occlusion. Figure 1 list of acute periodontal conditions, according to di. For differential diagnosis and treatment purposes, endo perio lesions are classified as either. A new classification of endodonticperiodontal lesions. 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. Others may be primarily periodontal and secondarily endodontic in origin. Treatment strategy for guided tissue regeneration in. Mandibular right irst molar had been hypersensitive to cold and sweets over the. Healthy periodontal tissues provide fibrous attachment of the root surface to the surrounding bone unhealthy pulpal tissue or an infected pulpal space can contribute to loss of the periodontal attachment more common for endo involved tooth to cause perio problem than the other way around. Some endo perio infections are primarily endodontic and secondarily periodontal in nature.
To critically evaluate the existing literature on acute lesions occurring in the periodontium periodontal abscesses pa, necrotizing periodontal diseases npd, and endo. Conversations occur daily between periodontists, endodontists, and general practitioners to try and ascertain whether a lesion surrounding one or more teeth is of periodontal or endodontic origin or is possibly is a true combined lesion that impacts both compartments and will require endodontic as well as subsequent periodontal. An untreated primary endodontic lesion can become secondarily involved with periodontal breakdown, which may clinically present with unusual signs and symptoms. The differential diagnosis of endodontic and periodontal diseases can sometimes be difficult, but it is of vital importance to make a correct diagnosis for providing the appropriate treatment. Pdf periodontal aspects of endodonticperiodontal lesions. He goes one step further and proposes a suggested new classification of the endo perio lesion, although. Pdf endodontic periodontal lesions occur as a combination of an endodontic infection and periodontal disease in a single tooth. Its management requires thorough understanding of wound healing process involving both endodontic and periodontal complex. The tooth with endo perio lesions should be evaluated thoroughly in terms of any cracks. Acute periodontal lesions periodontal abscesses and.
If we were to look at endo perio lesions that began from the endodontic tissue, there are a number of potential causes. Present case reports the multidisciplinary management of endo perio lesion by a skilled endodontist and an experienced periodontist. Decalcified freeze dried bone allograft dfdba, endo perio lesion, endodontic perforation. Pre treatment clinical and radiographic view post treatment clinical and radiographic view fig 3.
How to diagnose and treat periodontal endodontic lesions. Finally, there is a subset of lesions that are true endodontic periodontal lesions. A practical way to classify endo perio lesions for treatment planning purposes is to separate into three broad categories. The prognosis for successful management is highly dependent on proper initial classification and subsequent sequencing of treatment. This article explores and defines the three possible presentations of endodontic periodontal relationships that all clinicians face on a daily basis, and provides clarity to make accurate diagnosis simple and routine. Simon endodontic periodontal lesions present challenges to the clinician as. This article is an attempt to provide a rational approach to the perio endo endo perio question in order to scientifically diagnose and treat these lesions with predictable success.
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. Endodontic periodontal combined lesion is a clinical dilemma because making a differential diagnosis and deciding a prognosis are difficult. 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. After root canal treatment, an intracoronal splint was constructed and periodontal. Endoperio lesions periodontology notes dentalnotebook. Treatment of endoperiodontal lesion using leukocyteplateletrich. This is often a difficult diagnosis and therefore requires reevaluation after either the periodontal or endodontic problems are treated. The treatment of endoperiodontal lesion depends on the diagnosis. Management of endodonticperiodontic lesions springerlink.
Primary endodontic lesion with secondary periodontal involvement 4. The treatment of endodontic periodontal combined lesions requires both endodontic therapy and periodontal ic defects include. The prognosis of teeth with endoperiodontal lesion is poor but could. An endo perio lesion is one of the most common problems. The followup radiographs showed complete healing of the hard and soft tissue lesions. A diagram that summarises lesion development the relationships between them. The simultaneous involvement of pulpal problems and inflammatory periodontal disease can complicate diagnosis and treatment planning.
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