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. __TOC__

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