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Dental Tribune United Kingdom Edition

Feb 25- Mar 3, 2013United Kingdom Edition S cientific advances have segmented the field of den- tistry into a vast number of specialisations. Each specialised clinician performs a specific task. However, there are instances where treatment from single specialist will not eradicate the disease, the reason being the in- tricate nature of tooth, with its surrounding environment. In such cases it then becomes man- datory to adopt an interdiscipli- nary approach among profession- als for complete rehabilitation. An interdisciplinary approach is most commonly required in cases of an Endodontic-Periodontic lesion. The relationship between per- iodontal and pulpal disease was first described by Simring and Goldberg in 1964. Since then the term ‘Perio-Endo’ lesion has been used to describe these lesions. Perio-endo lesions arise from in- flammation or degeneration of both pulpal and periodontal tis- sues as a result of an intimate em- bryonic, anatomic and functional inter-relationship between them. The various pathways of com- munication between the pulp and the periodontium may be classi- fied as follows: I) Developmental pathways in- clude the apical foramen, lateral or accessory canals, dentinal tu- bules, developmental or lingual grooves II) Pathological pathways include empty spaces created by de- stroyed sharpey’s fibers, root frac- tures following trauma, idiopathic resorption (internal or external) and cemental agenesis or hypo- plasia. III) iatrogenic pathways include exposure of dentinal tubules fol- lowing root planning and acci- dental lateral perforations during endodontic treatment. Endodontic-periodontic dis- eases can be classified into: A. Primary endodontic disease: A chronic apical abscess may drain coronally through the peri- odontal ligament into the gingival sulcus. This condition may mimic clinically the presence of a perio- dontal abscess. Primary endodon- tic lesions usually heal following root canal treatment. B. Primary periodontal disease: These lesions are caused primar- ily by periodontal pathogens. In this process, chronic periodontitis progresses apically along the root surface. In most cases, pulp tests indicate a clinically normal pulpal reaction. C. Combined lesions: Primary endodontic disease with secondary periodontal involve- ment: If after a period of time a sup- purating primary endodontic dis- ease remains untreated, it may become secondarily involved with periodontal breakdown. The tooth now requires both endodontic and periodontal treatments. If the endodontic treatment is adequate, the prognosis depends on the se- verity of the periodontitis and the efficacy of periodontal treatment. With endodontic treatment alone, only part of the lesion will heal to the level of the secondary peri- odontal lesion. Primary periodontal disease with secondary endodontic involvement: The apical progression of a peri- odontal pocket may continue un- til the apical tissues are involved. In this case the pulp may become necrotic as a result of infection entering via lateral canals or the apical foramen. True combined disease: True combined endodontic–peri- odontal disease occurs less fre- quently than other endodontic– periodontal problems. It is formed when an endodontic disease pro- gressing coronally joins with an infected periodontal pocket pro- gressing apically. In most cases periapical healing may be antici- pated following successful endo- dontic treatment. This case report describes a case with most common symp- toms of pain and swelling. Case Report: A 35-year-old male patient re- ported to the Department of Peri- odontics, M.A.Rangoonwala Den- tal College and Research Center, Pune with the complaint of pain, swelling and pus discharge from the mandibular right posterior re- gionforfourtofivedays.Thetooth pain was moderately throbbing in nature and aggravated on masti- cation. The patient first noticed a small swelling in the gingiva which increased in size over three to four days. The medi- cal and dental history was non- contributory. On clinical examination the patient presented a small swell- ing in relation to mandibular right first molar. No caries or restora- tion was present. There was no evidence of vertical or horizontal Perio-endo lesion: Dilemma unfolded Dr Naylah Fajandar, MOs, Dr.Sneha R. Gokhale-Gaikwad, MDS, Dr. Sameer Jadhav, MDS, Dr. Vivek Hegde, MDS page 16DTà Fig1- pre-op periodontal abscess Sirona Dental Systems, Lakeside House, 1 Furzeground Way, Stockley Park, Heathrow, London UB11 1BD sirona.com Brilliant imaging quality from Sirona. T h e D e n t a l C o m p a n y 0845 0715040 info@sironadental.co.uk With the ORTHOPHOS XG family you can achieve Highest level of Image quality for panoramic, cephalometric & 3D images Crystal clear 2D images due to caesium iodide scinitilator material Reduction of metal artifacts with innovative MARS software HD 3D-sensor and smaller field of view for endodontics Low noise and high contrast for a reliable diagnosis Easy patient positioning Guided surgery Enjoy every day. With Sirona.