Combined periodontic-endodontic lesions are localized, circumscribed areas of
bacterial infection
Pathogenic bacteria are bacteria that can cause disease. This article focuses on the bacteria that are pathogenic to humans. Most species of bacteria are harmless and are often beneficial but others can cause infectious diseases. The number of ...
originating from either
dental pulp
The pulp is the connective tissue, nerves, blood vessels, and odontoblasts that comprise the innermost layer of a tooth. The pulp's activity and signalling processes regulate its behaviour.
Anatomy
The pulp is the neurovascular bundle cent ...
,
periodontal tissues surrounding the involved tooth or teeth or both.
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Cause
Combined periodontic-endodontic lesions take the form of
abscess
An abscess is a collection of pus that has built up within the tissue of the body. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid-filled when pressed. The area of redness often extends b ...
es and can originate from either or both of two distinct locations
and may be informally subclassified as follows:
#
Endo-Perio: infection from the pulp tissue within a tooth may spread into the bone immediately surrounding the tip, or apex, or the tooth root, forming a
periapical abscess
A dental abscess is a localized collection of pus associated with a tooth. The most common type of dental abscess is a periapical abscess, and the second most common is a periodontal abscess. In a periapical abscess, usually the origin is a bac ...
. This infection may then proliferate
coronally to communicate with the margin of the
alveolar bone
The alveolar process () or alveolar bone is the thickened ridge of bone that contains the tooth sockets on the jaw bones (in humans, the maxilla and the mandible). The structures are covered by gums as part of the oral cavity.
The synonymous ter ...
and the
oral cavity
In animal anatomy, the mouth, also known as the oral cavity, or in Latin cavum oris, is the opening through which many animals take in food and issue vocal sounds. It is also the cavity lying at the upper end of the alimentary canal, bounded on ...
by spreading through the
periodontal ligament
The periodontal ligament, commonly abbreviated as the PDL, is a group of specialized connective tissue fibers that essentially attach a tooth to the alveolar bone within which it sits. It inserts into root cementum one side and onto alveolar b ...
.
#
Perio-Endo: infection from a
periodontal pocket
Gingival and periodontal pockets (also informally referred to as gum pockets) are dental terms indicating the presence of an abnormal depth of the gingival sulcus near the point at which the gingival tissue contacts the tooth.
Tooth gingival inte ...
may proliferate via
accessory canals into the root canal of the affected tooth, leading to pulpal inflammation. Accessory canals may not be big enough to allow bacterial penetration, periodontal disease must reach the apex to induce an endodontic lesion.
Neither the
prognosis
Prognosis (Greek: πρόγνωσις "fore-knowing, foreseeing") is a medical term for predicting the likely or expected development of a disease, including whether the signs and symptoms will improve or worsen (and how quickly) or remain stabl ...
, treatment nor expected treatment outcome depend on the source of the infection.
A combined lesion may also be the result of a fractured tooth.
Treatment
Treatment includes conventional
endodontic therapy
Root canal treatment (also known as endodontic therapy, endodontic treatment, or root canal therapy) is a treatment sequence for the infected pulp of a tooth which is intended to result in the elimination of infection and the protection of ...
followed by
conventional periodontal therapy. If the lesion is deemed too severe for treatment, the involved tooth may require
extraction Extraction may refer to:
Science and technology
Biology and medicine
* Comedo extraction, a method of acne treatment
* Dental extraction, the surgical removal of a tooth from the mouth
Computing and information science
* Data extraction, the pro ...
.
References
{{DEFAULTSORT:Combined Periodontic-Endodontic Lesions
Bacterial diseases
Acquired tooth disorders