Operative dentistry aje qualtrough, jd satterthwaite la morrow, pa brunton

PERIO-ENDO CONNECTIONS
The pulp and the periodontal ligament are closely connected via:
• The apex or apices
• Other vascular channels (e.g. lateral and furcation canals)
• Dentinal tubules
Therefore, it is not surprising that there should be a relationship
between diseases of the pulp and the periodontium. In determining
the treatment for a particular tooth it is essential to know whether the
initial lesion is of periodontal or endodontic origin (Fig. 4.1).
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Chapter 4
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Classifications
The following classifications of endodontic and periodontal lesions
have been proposed:
• Lesions of endodontic origin
• Periodontal lesions
• Primary endodontic/secondary periodontal
Endodontics – further considerations


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Fig. 4.1
Origin and passage of infection in combined perio-endo lesions.
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• Primary periodontal/secondary endodontic
• Combined endodontic/periodontal lesions
Lesions of endodontic origin
Lesions of endodontic origin are simple periapical or lateral periodontal
granulomas (chronic apical/lateral periodontitis characterised by
aggregations of macrophages, lymphocytes and plasma cells) and
abscesses (acute apical/lateral periodontitis) recognised by the usual
clinical and radiographic features.
Periodontal lesions
Periodontal lesions are diagnosed on the basis of generally accepted
criteria including derangement of gingival architecture and loss of ging-
ival attachment as demonstrated by pocket probing and radiographs.
Primary endodontic/secondary periodontal
Endodontic disease may masquerade as periodontal disease in 
several ways:
• Drainage of a periapical lesion via the periodontal ligament, 
perhaps perforating the gingivae at, or near to, the mucogingival
junction, or exiting via the gingival crevice.
• Endodontic lesions formed via lateral canals at places on the root
surface other than at the apex.
• Lateral perforation of the root during root canal or post preparation
leading to a lateral periodontal abscess which may drain via the
gingival crevice.
• Endodontic lesions in furcation areas formed via ‘lateral’ canals
leading to abscesses, sinuses and radiographic bone loss, which
may look like periodontal disease.