ABSTRACT. Aim: This clinical case report demonstrates the successful management of a complex endodontic-periodontal iatrogenic lesion following a critical. An endo-perio lesion can have a varied pathogenesis which ranges from simple to relatively complex one. The differential diagnosis of. Shenoy N, Shenoy A. Endo-perio lesions: Diagnosis and clinical considerations. Indian J Dent Res [serial online] [cited Sep 28]; Available  ‎Abstract · ‎Periodontitis As. · ‎Clinical Diagnos. · ‎Lesions with Nar.


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They can get affected individually or combined; when both systems are endo perio lesion they are called true endo-perio lesions. The relationship endo perio lesion the periodontium and the pulp was first discovered by Simring and Goldberg in The pulp and periodontium have embryonic, anatomic and functional interrelationship.

There are various pathways for the exchange of infectious elements and irritants from the pulp to periodontium or vice versa, leading to the development of endodontic periodontal lesions.

Pathways of iatrogenic origin: Exposure of dentinal tubules following root planning Accidental lateral root perforation during endodontic procedures Root fractures during endodontic procedures. The main etiological factors for endo-perio lesions are living bacteria, fungi and viruses and nonliving pathogens.

International Journal of Dentistry

Along with these, many contributing factors such as trauma, root resorptions, perforations, and endo perio lesion malformations also play an important role in the development and progression of endo perio lesion lesions [4][5] [Figure 1].

The condition of the pulp is an important factor in susceptibility to microbial invasion. A vital pulp is very resistant to microbial invasion.

Penetration of the surface of a healthy pulp by oral bacteria is relatively slow or may be blocked entirely.

  • Endo-perio lesions: Diagnosis and clinical considerations Shenoy N, Shenoy A - Indian J Dent Res
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In contrast, endo perio lesion necrotic pulp is endo perio lesion invaded and colonized by bacteria. Nature and extent of periodontal destruction depends on various factors such as virulence of microorganisms, duration of the disease and the host defense mechanism. Similarly, the reverse of the effect of a necrotic pulp on the periodontal ligament, has been referred to as retrograde pulpitis.


Endodontics deals primarily with disease of the pulp and periapical tissues. The success of both periodontal and endodontic therapy depends on the elimination of both disease processes, whether they exist separately or as a combined lesion.

The relationship between periodontal and endodontic disease has been a subject of speculation for many endo perio lesion. Frequently, the presence of a sinus tract is associated with a necrotic pulp. Palpation Palpation is endo perio lesion by applying firm digital pressure to the mucosa covering the roots and apices.

With the index finger the mucosa is pressed against the underlying cortical bone. This will detect the presence of periradicular abnormalities or ''hot'' zones that produce painful response to digital pressure.

An abnormal positive response indicates inflammation of the periodontal ligament that may be either from pulpal or periodontal origin. The sensitivity of the proprioceptive fibers in an inflamed periodontal ligament will help identify the location endo perio lesion the pain.

This test should be performed gently, especially in highly sensitive teeth. Mobility Tooth mobility is directly proportional endo perio lesion the integrity of the attachment apparatus or to the extent of inflammation in the periodontal ligament. In cases of primary endodontic pathology, the mobility resolves within a week of initiating endodontic therapy.


Radiographs Interpretation of discrete periapical or lateral lesions and discrete periodontal lesions is of clinical importance in suggesting the endo perio lesion of the lesion and the proper diagnostic procedures to follow to confirm the cause.

They have the potential to cause root resorption.

The periodontal – endodontic continuum: A review

The irritating chemical may diffuse through the dentinal tubules, and when combined with heat, they are likely to cause necrosis of the cementum, inflammation of the periodontal ligament, and subsequently root resorption [ 3637 ].

Replacement resorption or ankylosis occurs following extensive necrosis of the periodontal ligament with formation of bone onto a denuded area of the root surface. This condition endo perio lesion most often seen as a complication of luxation injuries, especially in avulsed teeth that have been out of their sockets in endo perio lesion conditions for several hours.

The potential for replacement resorption was also associated with periodontal wound healing. Granulation tissue derived from bone or gingival connective tissue may induce root resorption and ankylosis [ 17 endo perio lesion, 31 ].


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