Combined periodontic-endodontic lesions

A perio-endo lesion is a form of periodontal disease, proceed with the pathogen from Endodont on the periodontium, or vice versa.

We distinguish three forms:

• Lesions with primary endodontalem origin
• Lesions with primary periodontal origin
• Lesions with a combined endo and periodontal origin

Anatomical and Pathological causes

Between Endodont ( pulp ) and periodontal tissues ( periodontium ), there are several direct connections. First, the network of nerves and blood vessels occurs at the apex ( root tip ) from the tooth to the bone. In addition, can be found in approximately one third of all permanent teeth additional lateral channels, leaving the pulp side before the apex. In multi-rooted teeth of the roots ( furcation ) also found in the area of the bifurcation often accessory canals that connect the coronal pulp directly to the periodontium. About all these lines of communication can move theoretically microorganisms between periodontal and Endodont. The direction and speed of the bacterial propagation depends on the origin of the type infection and the initial state of the involved tissues. On the one hand, bacteria which have been infected by a deep caries the pulp chamber, the passage of time along the connecting channels reach the surrounding periodontal tissues and is also ignited. Conversely, there is also the possibility that the microorganisms initially colonize the periodontium and then ignite the numerous channels that Endodont, this inflammatory progression is rare.

Primary endodontic lesions

The primary endodontic lesions have their origin in deep carious lesions. Once the bacteria have reached the pulp chamber, they can completely spread within a few days in it. If the pulpitis treated early enough, the microorganisms can over the apex, but also through other side channels that reach the periodontium and also colonize. Depending on location, this inflammation is on the radiograph as apical periodontitis, if it is at the root tip, or lateral periodontal disease, which is located at a lateral channel output. If a treatment is further omitted, the inflammation can spread in the bone and eventually penetrate along the root surface to the sulcus.

The treatment of primary endodontic lesions lies in a proper root canal treatment. Here, a curettage is initially contraindicated, as in this case the periodontal fibers are removed. Remain bone defects with very pronounced lesions after completion of root canal treatment, curettage should be performed only with a significant time lag, since the damaged periodontal tissues usually can recover on its own. Thus primary endodontic lesions have the best chances of a complete cure.

Primary Periodontal lesions

As unfavorable estimate are the primary periodontal lesions that have their origin in distinct periodontal pockets. If left untreated, the bone defects can reach to the root tip and infected by retrograde ( from the root tip ), the pulp chamber. In this case, there are no carious lesions, one of which pulpitis is assumed. Although the actual colonization of the dental pulp is controversial in this way in the literature, provides such a deep lesion at the latest in therapy impairment of the vitality of the tooth dar. However, a thorough curettage in this area damage can not be excluded on the dental pulp.

The therapy of primary periodontal lesion on a tooth, showing the clinical signs of a still vital dental pulp, so initially located in a curettage, which is closed depending on locality or carried out openly. An endodontic therapy is given when the bone lesion extends to the apex. If necessary, an apicoectomy may also be required. Here, the prognosis for the tooth, however, is already restricted.

Combined Periodontal and endo lesions

From combined lesions is when have evolved independently in both periodontal inflammation and an endo at the same root. If these are not treated, they can spread as far as the course of time that the events overlap each other. In addition, there is often talk of combined lesions when the actual origin at the time of diagnosis no longer can understand.

The treatment of combined perio-endo lesions similar to the lesions of periodontal origin, but the root canal treatment must be carried out in any case. However, the prognosis of teeth is always to be considered by such serious infections as very questionable. Therefore, in many cases, only the extraction or root amputation can lead to healing. Lesions of unclear origin should be done first root canal treatment and curettage be connected to a sufficient time interval as needed. But here is the fundamental decision whether a tooth is at all salvageable or whether it should not be extracted better from the outset with an unfavorable prognosis.

Root amputation

In the permanent dentition have the molars of the upper and lower jaw and the first premolar of the upper jaw more than one root. Is not worth preserving only one of these roots due to a fraction or a perio-endo lesion, sometimes has the opportunity to remove only this. For this, the root must be easily accessible and the remaining teeth have a good prognosis. In order to perform a root amputation, first a successful root canal treatment must be carried out. Subsequently, the root in question may be separated and removed in an orally surgical operation. The remaining tooth is then closed in the area of ​​amputation wound with a filling and was later eg be fitted with a prosthesis with a crown. This type of treatment has been established during the period when implants still do not constitute a viable alternative. Since this selection procedure, a private co-payment from the patient is necessary nowadays both possibilities must be weighed against each other.

• Disease in dentistry