Strategies for the endodontic management of concurrent endodontic and periodontal diseases

By Abbott PV, Salgado JC

Date: 08/2010
Journal: Australian Dental Journal


Purpose:    The aims of this paper were to review the literature, to develop a simple classification system and to provide a rational approach to managing teeth with concurrent endodontic and periodontal diseases.

Pulp and periapical conditions that may have periodontal manifestations :

•Some endodontic diseases may have manifestations that affect the periodontal tissues. In particular, a chronic apical abscess may appear to be associated with a periodontal pocket. In some cases, the draining sinus may be located immediately adjacent to the gingival sulcus

• Irreversible pulpitis rarely,  will cause periodontal or osseous defects, although it is possible that one canal may have irreversible pulpitis while one or more of the other canals or the pulp chamber is infected – this situation has been termed ‘‘pulp necrobiosis’’.

4 The Periodontal conditions that may affect the pulp and ⁄ or periapical tissues :

Pulp inflammation and secondary dentine formation has been reported as being associated with periodontal diseases, as has internal resorption. These pulp changes were reported to only occur when the periodontal pockets extended deep enough to involve lateral canals or dentinal tubules associated with exposed root dentine or root caries. •Root planing is an operative procedure of the tooth that may cause pulp inflammation of varying degrees, depending on the extent of the procedure itself, the amount of cementum removed, whether the exposed dentine is protected by a smear layer and the ability of the pulp to respond to any irritant.

•In some patients, the bone loss associated with a very deep periodontal pocket may extend beyond the root apex. In this situation, it can mimic a periapical radiolucency so a careful  examination of the tooth is essential.

Classification of endodontic-periodontal diseases  :

Acommonly-used classification for endodontic-periodontal diseases was first suggested by Simon et al .  This classification included five categories which were based on the concept of having primary and secondary diseases:

(1) primary endodontic lesion;

(2) primary endodontic lesion with secondary periodontal involvement

(3) primary periodontal lesion;

(4) primary periodontal lesion with secondary pulp involvement; and (5)‘‘true combined’’endodontic-periodontal lesion.

 Classification of endodontic-periodontal diseases  :  classification of endodontic and periodontal diseases be limited to those teeth that have both endodontic and periodontal diseases occurring at the same time  , so it is proposed that they should be called ‘‘concurrent diseases’’ rather than ‘‘combined endo-perio  lesion which is divided into 2 types : (1)Concurrent endodontic and periodontal diseases without communication lesions and (2) Concurrent endodontic and periodontal diseases with communication

Concurrent endodontic and periodontal diseases without communication :  ideally, conventional endodontic treatment should be carried out prior to any periodontal treatment . 

Concurrent endodontic and periodontal diseases with communication : Ideally, they should be managed concurrently although in planned and sequenced stages to reduce possible complications.

Prognosis : the prognosis will depend on many factors such as :  the primary cause of the diseases,  the amount of attachment loss prior to treatment,  the patient’s healing responses and  oral hygiene of the patient

Conclusion : establishing a correct diagnosis  is the most important phase of the management as the diagnosis will determine the type and sequence of treatment required.