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

Primary periodontal/secondary endodontic
Chronic periodontitis may lead to pulpal disease by means of direct
bacterial invasion, or trauma during root surface instrumentation as
part of treatment. Chemicals and obtundents used to relieve dentine
sensitivity may irritate the pulp, as may the exposure of root surfaces
by gingival recession. There is some disagreement in the literature
about whether this really happens, mainly because many teeth with
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significant periodontal disease also have large restorations, so it is
impossible to know whether the pulpal lesion was caused by caries,
restoration or periodontitis.
Combined endodontic/periodontal lesions
Combined endodontic/periodontal lesions may be:
• Independent of one another
• Coalescing
Differential diagnosis
Differential diagnosis is based upon interpretation of information
gained from the following:
• History:
—
pain (duration and character)
• Clinical examination:
—
swelling (site, type and character)
—
discharge (type of fluid, blood, pus etc.)
—
percussion (gentle percussion in several directions)
—
mobility
• Special tests:
—
vitality/sensibility testing (electrical and/or thermal,
mechanical)
—
periodontal probing
—
test cavity
—
radiographs (parallax views if necessary)
Treatment planning
In determining the treatment to be provided, an assessment of the
vitality of the tooth in question is required. In some instances, it may
not be clear whether the pulp is vital or not. In these cases a judgement
must be made based on the available evidence from the history and
clinical appearance (including special investigations) and treatment
instigated. The options for treatment are summarised below:
• Pulp judged to be healthy:
—
periodontal therapy
—
reassessment: if unsuccessful commence endodontic
Endodontics – further considerations


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therapy. 
If successful no further treatment.
• Pulp judged to be unhealthy:
—
endodontic therapy
—
reassessment: if unsuccessful commence periodontal
therapy. If successful no further treatment.