Endo - Perio Lesions /fixed orthodontic courses by IDA

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats. Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics, Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call 0091-9248678078

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ENDODONTIC - PERIODONTIC INTERRELATIONSHIP www.indiandentalacademy.com

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www.indiandentalacademy.com INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com

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CONTENTS INTRODUCTION DEFINITION CLASSIFICATION ETIOLOGY CONTROVERSIES REGARDING THE COMBINED LESION PATHWAYS OF SPREAD COMPARISION OF CLINICAL PRESENTATION B/W APICAL & MARGINAL PERIODONTITIS DIFFERENTIAL DIAGNOSIS EFFECT OF PULP & ITS TREATMENT ON PERIODONTIUM EFFECT OF PERIO. DISEASE & TREATMENT ON PULP PERIODONTAL EVALUATION LESIONS DIAGNOSIS TREATMENT REFERENCES CONCLUSION www.indiandentalacademy.com

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DEFINITION An isolated, usually narrow, deep probing depth of pulpal or periodontal origin. Lesion with sub marginal or intrabony periradicular bone loss of pulpal and/or periodontal origin that communicates with the oral cavity via probing defect. A localized periodontal probing depth of pulpal or periodontal origin. STOCK www.indiandentalacademy.com

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CLASSIFICATION Primary endodontic lesion Primary endodontic lesion with secondary periodontal involvement Primary periodontal lesion Primary periodontal lesion with secondary endodontic involvement True combined lesion Concomitant pulpal & periodontal lesion COHEN DIA PG 654 www.indiandentalacademy.com

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Tooth in which symptoms clinically and radiographically simulate periodontal disease but are due to pulpal inflammation Tooth that has both pulpal and periodontal disease concomitantly Tooth has no pulpal problem but require endodontic therapy plus root amputation to gain periodontal healing Tooth that clinically and radiographically simulated pulpal or periapical disease but infact has periodontal disease WEINE www.indiandentalacademy.com

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necrotic pulp and apical granulomatous tissue replacing periodontium with or without sinous tract Chronic periapical abscess with sinus tract Longitudinal and horizontal root fractures Pathologic and iatrogenic root perforations Teeth with incomplete apical root development Endodontic implants Teeth that require hemisection Root submergence LESIONS REQUIRING ENDODONTIC TREATMENT ONLY GROSSMAN www.indiandentalacademy.com

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Occlusal trauma causing reversible pulpitis Occlusal trauma plus gingival inflammation resulting in pocket formation and reversible pulpitis Suprabony or infrabony pocket formation treated with overzealous root planning and curettage leading to pulpal sensitivity Extensive infrabony pocket formation extending beyond the root apex and sometimes coupled with lateral or apical resorption yet with pulp that responds with in normal limits to clinical testing LESIONS REQUIRING PERIODONTAL TREATMENT ONLY www.indiandentalacademy.com

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Any lesion in Group I That results in irreversible reactions in the attachment apparatus and requires periodontal treatment Any lesion in Group II that results in irreversible reactions to the pulp tissue and also requires endodontic treatment LESIONS REQUIRING COMBINED ENDO – PERIO TREATMENT www.indiandentalacademy.com

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ETIOLOGY ATYPICAL ANATOMIC FACTORS Malaligned tooth Multirooted teeth / additional root Additional canal Cervical enamel projection Large lateral / accessory canal TRAUMA With gingival inflammation Tooth fracture Pulp / perio involvement + sinus tract Cellular changes - resorption www.indiandentalacademy.com

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MISCELLANEOUS Iatrogenic systemic SINUS TRACT INFRABONY POCKET From canal Narrow From gingival crevice wide www.indiandentalacademy.com

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CONTROVERSIAL ASPECT CONCERNING THE COMBINED LESION PULPAL PERIODONTAL PERIODONTAL PULPAL ? Chacker Massler Venous blood flow outward Czarnecki & Schilder Drawback Lateral / accesory canal - flow bothways Seltzer & bender Stahl www.indiandentalacademy.com

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PATHWAYS Physiologic : Apical foramen Lateral canals Dentinal tubules Periodontal ligament Alveolar bone Neural pathways Vasculolymphatic pathway Iatrogenic : Palatogingival grooves Cementum defect Vertical root fractures Perforations www.indiandentalacademy.com

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COMPARISION MARGINAL PERIODONTITIS APICAL PERIODONTITIS Cervical Apex Plaque Pulpal inflammation Horizontal / Vertical bone loss - generalized Seldom bone loss – localized & deep Open Contained www.indiandentalacademy.com

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Attachment loss asso. with Anatomic defect on root Nature of pathogenic flora Necrotic & infected pulp Host defense mechanism defect. Aggresiveness asso with Lateral & apical foramen Nature of flora Apical host defense Periodontal probing & radiographic examination Radiographic examination www.indiandentalacademy.com

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DIFFERENTIAL DIAGNOSIS PULPAL PERIODONTAL CLINICAL Cause pulp infection periodontal Vitality non vital vital Restorative deep or extensive not related Plaque /calculus not related primary cause Inflammation acute chronic Pockets single and narrow multiple and wide coronally pH value acidic alkaline Trauma primary or secondary contributing factor Microbial few complex www.indiandentalacademy.com

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RADIOGRAPHIC Pattern localized generalized Bone loss wider apically wider coronally Periapical radiolucent not related Vertical bone loss: no yes HISTOPATHOLOGY Junctional epithelium no apical migration present Granulation tissues apical (minimal) coronal (larger) Gingival normal recession TREATMENT Therapy RCT Periodontal therapy www.indiandentalacademy.com

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Problems in diagnosis : Vertical root fracture: varied radiographic picture Different angulations Surgical exposure lateral condensation excessive Post placement Extensive restorations Older patients Gingival sulcus & pocket area Single rooted teeth multirooted teeth Cause Developmental grooves In doubt ? – Biopsy / Histological analysis Systemic diseases mimic lesion on radiograph : Scleroderma Metastatic carcinoma Osteosarcoma www.indiandentalacademy.com

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EFFECT OF PULP AND ITS TREATMENT ON PERIODONTIUM Periodontal inflammation & bone loss Sub marginal bone loss Horizontal bone loss Vertical intrabony pockets Furcation involvement Periodontal wound healing Traumatized necrotic pulp RC infection – compromised healing Gingival tissue thickness Alveolar bone level Surgical trauma to flap Effective flap repositioning Root canal treatment Doubtful pulpal status Iatrogenic problems www.indiandentalacademy.com

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EFFECT OF PERIODONTAL DISEASE & ITS TREATMENT ON PULP Periodontal disease & pulp Limited Channels closed + dystrophic calcification- chronic Sufficient viurlence – pulpal disease Poor prognosis Extraction / Root resection Periodontal treatment & pulp Scaling & root planing – excessive cementum removal Compromised pulp www.indiandentalacademy.com

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www.indiandentalacademy.com Thank you www.indiandentalacademy.com Leader in continuing dental education

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