Combined periodontic-endodontic lesions

Combined periodontic-endodontic lesions are localized, circumscribed areas of bacterial infection originating from either dental pulp, periodontal tissues surrounding the involved tooth or teeth or both.^[1]

Source of infection

Periapical readiograph of lower right teeth, showing a large carious lesion in the distal of the lower right second molar. The same tooth also has an extensive periodontal defect. At this stage, without further information, it is difficult to tell which process has occurred first and lead to the death of the pulp.

Combined periodontic-endodontic lesions take the form of abscesses and can originate from either or both of two distinct locations^[1] and may be informally subclassified as follows:

Endo-Perio: infection from the pulp tissue within a tooth may spread into the bone immediately surrounding the tip, or apex, or the tooth root, forming a periapical abscess. This infection may then proliferate coronally to communicate with the margin of the alveolar bone and the oral cavity by spreading through the periodontal ligament.
Perio-Endo: infection from a periodontal pocket may proliferate via accessory canals into the root canal of the affected tooth, leading to pulpal inflammation.

Neither the prognosis, treatment nor expected treatment outcome depend on the source of the infection.^[2]

A combined lesion may also be the result of a fractured tooth.

Treatment

Treatment includes conventional endodontic therapy followed by conventional periodontal therapy. If the lesion is deemed too severe for treatment, the involved tooth may require extraction.

References

1 2 American Academy of Periodontology (May 2000). "Parameter on acute periodontal diseases. American Academy of Periodontology" (PDF). J. Periodontol. 71 (5 Suppl): 863–6. doi:10.1902/jop.2000.71.5-S.863. PMID 10875694.
↑ American Academy of Periodontology (1999). "Consensus report: Periodontic-Endodontic Lesions". Ann. Periodontol. 4 (1): 90. doi:10.1902/annals.1999.4.1.90.

Dentistry involving supporting structures of teeth (Periodontology)

Anatomy

Disease

Diagnoses	Chronic periodontitis Localized aggressive periodontitis Generalized aggressive periodontitis Periodontitis as a manifestation of systemic disease Periodontosis Necrotizing periodontal diseases Abscesses of the periodontium Combined periodontic-endodontic lesions

Infection	A. actinomycetemcomitans Capnocytophaga sp. F. nucleatum P. gingivalis P. intermedia T. forsythia T. denticola Red complex

Other	Calculus Clinical attachment loss Edentulism Fremitus Furcation defect Gingival enlargement Gingival pocket Gingival recession Gingivitis Horizontal bony defect Linear gingival erythema Occlusal trauma Periodontal pocket Periodontal disease Periodontitis Plaque Vertical bony defect

Treatment and prevention	Periodontal examination Ante's law Brushing Bleeding on probing Chlorhexidine gluconate Flossing Hydrogen peroxide Mouthwash Oral hygiene Tetracycline Triclosan Host modulatory therapy

Treatment

Conventional therapy	Debridement Scaling and root planing Full mouth disinfection Full mouth ultrasonic debridement

Surgery	Apically positioned flap Bone graft Coronally positioned flap Crown lengthening Open flap debridement Gingival graft Gingivectomy Guided bone regeneration Guided tissue regeneration Enamel matrix derivative Implant placement Lateral pedicle graft Pocket reduction surgery Socket preservation Sinus lift Subepithelial connective tissue graft Tools Curette Membrane Probe Scaler

Important personalities

Other specialties

Endodontology
Orthodontology
Prosthodontology

Acquired tooth disease (K02–K05, 521–525)

Hard tissues

Pulp/periapical (Endodontal)

Pulpal	External resorption Internal resorption Irreversible pulpitis Reversible pulpitis Pulp necrosis Pink tooth of Mummery

Periapical	Acute apical periodontitis Chronic apical periodontitis Combined periodontic-endodontic lesions Fistula Periapical abscess Phoenix abscess Vertical root fracture

Ungrouped	Pulpitis Radicular cyst Periapical abscess

Gingiva/periodontal
(Periodontal)

Bone cyst

Other

Cracked tooth syndrome

To be grouped
from periodontology

Diagnoses	Chronic periodontitis Localized aggressive periodontitis Generalized aggressive periodontitis Periodontitis as a manifestation of systemic disease Necrotizing periodontal diseases Abscesses of the periodontium Combined periodontic-endodontic lesions

Pathogenesis	A. actinomycetemcomitans Capnocytophaga sp. F. nucleatum P. gingivalis P. intermedia T. forsythia T. denticola

Pathologic entities	Calculus Edentulism Fremitus Furcation defect Gingival enlargement Gingival pocket Gingivitis Horizontal bony defect Linear gingival erythema Occlusal trauma Periodontal pocket Periodontal disease Periodontitis Plaque Recession Vertical bony defect

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