The Periodontal-Endodontic Relationship, What Do We Know?

Abstract

Diagnosis and management of periodontal-endodontic lesions are often complicated by the close interrelationship between periodontal tissues and dental pulps. Communications between both biological entities may occur through the apical foramen, accessory canals or exposed dentinal tubules, allowing bi-directional spread of infection and/or inflammation. Endodontic and periodontal lesions may occur distinctly or in tandem. Infected pulps may provoke an inflammatory response in adjoining periodontal tissues, and induce tissue destruction, and likewise, periodontal infection may elicit progressive pulpal pathoses. Solely periodontal or solely endodontic lesions are often clinically recognizable as distinct pathologies. However reported pain from pulpal or periodontal tissues may be similar, especially in combined lesions in which both endodontic and periodontal infection co-exist. When combined lesions develop, signs and symptoms such as toothache, tooth mobility, increased probing pocket depths and localized swelling may develop concurrently. As such, appropriate diagnostic tests and detailed clinical examination are required to differentiate periodontal, endodontic and combined pathologies and to arrive at correct diagnoses. Successful treatment outcomes for any periodontal and/or endodontic lesion depend on correct diagnosis and timely implementation of appropriate therapies. In this chapter, available evidence on periodontal-endodontic lesions will be reviewed with classification, clinical presentations, prognoses and treatment modalities discussed collectively.

Cervical enamel projections from a periodontal perspective: A scoping review

“…This reduced mineralized makes CEP enamel more prone to dissolution by acid (Gaspersic, 1992). Third, susceptibility related to the attachment between the tooth and periodontal tissue would involve lack of Sharpey's fiber insertion, which is present on the tooth root with a normal smooth CEJ line (Kai Ling et al, 2018). On the CEP, connective tissue attachment and Sharpey's fiber insertion cannot occur and only hemidesmosomal attachment is allowed (Kai Ling et al, 2018; Schroeder & Listgarten, 1971).…”

“…Third, susceptibility related to the attachment between the tooth and periodontal tissue would involve lack of Sharpey's fiber insertion, which is present on the tooth root with a normal smooth CEJ line (Kai Ling et al, 2018). On the CEP, connective tissue attachment and Sharpey's fiber insertion cannot occur and only hemidesmosomal attachment is allowed (Kai Ling et al, 2018; Schroeder & Listgarten, 1971). This attachment is considered less resistant to periodontal breakdown than fiber attachment on other root surface (Goldstein, 1979; Kai Ling et al, 2018).…”

“…On the CEP, connective tissue attachment and Sharpey's fiber insertion cannot occur and only hemidesmosomal attachment is allowed (Kai Ling et al, 2018; Schroeder & Listgarten, 1971). This attachment is considered less resistant to periodontal breakdown than fiber attachment on other root surface (Goldstein, 1979; Kai Ling et al, 2018). Consequently, this vulnerability may predispose the site to deepened probing depths especially when gingival inflammation exists (Chan et al, 2010).…”

Root Canal Infection and Its Impact on the Oral Cavity Microenvironment in the Context of Immune System Disorders in Selected Diseases: A Narrative Review

“…The exposed cervical dentine, not covered by either cement or enamel, also provides tubular communication through the dentinal tubules. This type of connection also occurs in physiological root resorption [ 16 , 30 , 31 , 32 , 33 , 34 ]. Even cementum itself does not provide perfect tightness.…”

“…In addition to these, there are also indirect connections, such as deep root fissures, which can cause periodontal thinning, thus allowing the irritant to pass through the tooth structure. The variety and variability of physiological and pathological communication pathways between the pulp and periodontal tissues indicate a very complex relationship between these two types of tissues [ 31 , 33 , 34 , 35 , 36 ].…”