How would you differentiate between a primary endodontic lesion with secondary periodontal involvement and a true combined endo-perio lesion, and what implications does this have for treatment planning?
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- A primary endo case has its origin in caries or trauma causing pulp pathology.
- A perio case has its origin in plaque and calculus leading to gingivitis, pocket formation and periodontitis.
- however because of pathways of communication between the pulp and the periodontium like the apical foramen, lateral canals, dentinal tubules, etc, an endo condition may spread to the periodontium and vice versa when it is combined endo-perio case.
- True endo perio lesions have culmination of endo and perio pathologies.
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Difference:
In primary endo secondary Perio lesion - tooth becomes nonvital, with a narrow periodontal defect might be associated with pus.
In a true combined lesion - the tooth becomes nonvital with the large periodontal defect. In this case, it is difficult to tell which lesion started first.
Treatment implications:
Depends on the root damage, lesion occurring in periodontitis patients or non-periodontitis patients.
Diagnosing endo-perio lesions can be complicated, as they involve both pulp and periodontal components. Clinical findings, radiographs, vitality tests, and probing are used.
The primary endodontic lesion with secondary periodontal involvement starts in pulp and spreads to periodontium, it usually heals after root canal treatment.
A true combined lesion has independent periodontal and endodontic diseases needing both root canal and periodontal therapy for solution.
Informative discussion