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DifferentialDifferentialDiagnosisDiagnosis

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EN DODONTAL Primary endodontic disease

PERI ODONTAL Primary periodontal diseaseCOMBINE D

Primary endodisease with

secondary pdldisease

Primary pdldisease with

secondaryendodontal

disease

T ruecombineddisease

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Primary EndodonticPrimary Endodontic

DiseaseDisease

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H ealthy PeriodontalH ealthy Periodontaltissuestissues

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Primary Periodontal DiseasePrimary Periodontal Disease

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Primary Endo.diseasePrimary Endo.disease

with secondarywith secondaryPerio. involvementPerio. involvement

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Root perforationRoot perforation

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Primary Perio. diseasePrimary Perio. disease

with secondarywith secondaryEndo. involvementEndo. involvement

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T rue Combined LesionT rue Combined Lesion

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Diagnostic A idsDiagnostic A ids

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Radiograph

probing

True combinedperio-endo

lesion

conical+narrow probingat base of defect

Pulpless toothwith separate

pdl defect

conicalwnl

EndoBroad,precipitous

Endo

narrow EndoPulp test

probing

conical Periownl Pathosis;

possible biopsy

narrowExceptions: enamelspurs,dev.grooves,

defect after trauma

-ve

+ve

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Clinicalfindings

Endo lesion Perio lesion

Pulpal response -nt +ntCaries/coronalrestoration

+nt -nt

Bony deformity pattern

tubular triangular

Plaque

&calculus

-nt +nt

Mobility -nt +nt

Generalizedperiodontitis

-nt usually +nt

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Clinicalfindings

Endodontic L Combined L

Pulpal status necrotic necroticPdl status normal Gen.

periodontitis

probing Narrow ,U-shaped pocket

Wide V-shapedpocket

Plaque & calculus --ntnt +nt

Treatment Endodontics Endodontics &Periodontics

Prognosis good Depends onperiodontal

therapy

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T reatment

T reatment

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Root canal treatment

Root canal treatment

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AAPP

I I CC

EECCTT

OOMM

YY

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OschenbeinOschenbein--Luebke flapLuebke flap

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T riangularT riangularflapflap

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Semilunar

Semilunarflapflap

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A lternative treatmentA lternative treatment

approachesapproaches

Root resection Bicuspidization

H emisection

Resective

Regenerative

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Root ResectionRoot Resection

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Preop

Resection ofthe mesiobuccal

root

Post opA fter 5 years

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1st molarwith extensivebone loss

Wedge displayingexposure ofthe furcation

Bicuspidization

Maintenance ofrestoration Restoration

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H emisectionH emisection

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H emisection

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Gingival

Gingivalflapflap

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RectangularRectangularflapflap

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E ffect ofE ffect ofinappropriateinappropriate

endodonticendodontic

treatment ontreatment onperiodontal healthperiodontal health

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PoorPoorrootrootfillingfilling

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Endodontic lesionwhere the post has

perforated the distalroot of lower molar

Perforationconfirmation using

gutta purcha

Root perforationRoot perforation

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Post removed& perforation

sealed

5 month post op

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Chemical irritationChemical irritation

by medicamentsby medicaments

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OverzealousOverzealousroot canalroot canalinstrumentationinstrumentation

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E ffect ofE ffect ofPeriodontalPeriodontaltreatmenttreatment

on pulpon pulp

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S caling & Root PlaningS caling & Root Planing

Plaque depositsI

nflamed gingiva

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Hypersensitivity

Hypersensitivity

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ControversiesControversiesI s Perio. disease cause of pulp necrosis ??

Combined lesions ??

Can a pulpless tooth be the cause of Perio.disease ??

I mpact of Endo. infection on Perio. Woundhealing ??

Making periapical granuloma sterile??

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