Combined periodontal and endodontic lesions

Combined periodontal and endodontic disease is a very complex oral disease, which is mainly caused by the simultaneous existence of pulp inflammation and periodontal destruction. The two influence and spread each other, leading to the occurrence of combined lesions. Periodontal and endodontic combined diseases are very harmful. After suffering from this disease, timely treatment should be carried out to minimize the damage. Let’s take a closer look at the treatment of combined periodontal and endodontic diseases.

The communication pathways between periodontal tissue and pulp tissue:

1. Apical foramen: It is an important passage for periodontal tissue and dental pulp. Blood vessels, nerves and lymph are interconnected through the apical foramen, and infection and inflammation are also easy to spread cross-wise.

2. Root canal lateral branches (Figures 1, 2): These are the communicating branches on the side walls of the tooth root. They are most numerous in the 1/3 near the apex. Therefore, when the deep periodontal pocket reaches the 1/3 near the apex, the chance of the pulp being affected increases greatly. In addition, approximately 20%-60% of teeth in the root bifurcation area of ​​multi-rooted teeth have lateral branches (or accessory root canals).

3. Dentin tubules: The surface of normal tooth roots is covered with cementum, but about 10%-18% of teeth have no cementum covering the cervical area, and the dentin is directly exposed. In front teeth, the rate can be as high as 25%. In addition, the cementum at the neck of the tooth is usually very thin and can be easily scraped off or, when the gums recede, the thin layer of cementum is worn away by hard brushing, exposing the dentin underneath. The toxic products of plaque bacteria, drugs, and dyes can penetrate in both directions and affect each other.

Anatomical abnormalities: such as palatal deformed groove of maxillary anterior teeth, cementum dysplasia, external root resorption, root fracture, etc.

Disease treatment

We should try our best to find out the primary cause of the disease, actively deal with periodontal and pulp lesions, and completely eliminate the source of infection. The prognosis of pulpal periapical disease is good after thorough and regular endodontic treatment; the predictability of the efficacy of periodontal lesions is not as good as that of pulp disease. Therefore, the prognosis of periodontal-endodontic combined lesions depends to a large extent on the prognosis of periodontal lesions. The prognosis of periodontal lesions caused by endodontic apical lesions is generally good.

1. For teeth with periodontal lesions caused by apical pulp lesions, endodontic treatment should be performed as soon as possible. For patients with a short course of disease, periodontal lesions are just a channel for pus drainage and can heal after root canal treatment. If the disease lasts for a long time, epithelium will grow into the periodontal pus drainage channel, plaque and tartar will penetrate into the pocket, and periodontitis lesions will be established. The efficacy of the disease mainly depends on the effect of periodontal treatment. At this time, the more reasonable treatment sequence is: clear the infected pulp in the pulp cavity - clear the infection in the periodontal pocket - complete root canal filling. If the bone has not been repaired several months after completing the above treatment, or the periodontal pockets are still deep and the inflammation cannot be controlled, further periodontal treatment such as flap surgery can be performed.

2. If the tooth has deep periodontal pockets but pulp vitality test shows that the pulp is still vital, periodontal treatment can be performed first to observe the effect. If the effect is not good, the vitality of the pulp needs to be confirmed again. For teeth whose pulp vitality is still there but has become dull, it is not advisable to be too conservative and pulp treatment should be performed at the same time, which is conducive to the healing of periodontal lesions.

3. Retrograde pulpitis: Whether the affected tooth can be retained depends mainly on the periodontal lesions of the tooth and the prognosis of periodontal treatment. Treatment sequence: Clear the infected pulp in the pulp cavity - Clear the infection in the periodontal pocket - Complete root canal filling. For pulpitis caused by deep periodontal pockets in only one root of a multi-rooted tooth, and the affected tooth is not loose, the affected root can be removed to retain the affected tooth after the root canal treatment and periodontal treatment are completed. If the periodontal disease is very serious or the affected tooth is too loose, you can consider tooth extraction directly.

When the pathogen cannot be determined, endodontic treatment should be performed first for dead teeth in combination with periodontal treatment; for vital teeth, periodontal treatment and occlusal adjustment should be performed first. If the effect is not good, endodontic treatment can be performed depending on the situation.