Evaluation of Endodontic Status on Periodontal Healing of Concomitant Endodontic Periodontal Lesions

Title: EVALUATION OF ENDODONTIC STATUS ON PERIODONTAL HEALING OF CONCOMITANT ENDODONTIC PERIODONTAL LESIONS

INTRODUCTION:

Although deleterious effects of endodontic tissue on the periodontium are well documented, the converse effect of periodontal disease on pulp remains unclear. There is abundance of research on the avenues of communication but still many doubts exist. High prevalence of accessory canals has been seen but not all primary endodontic lesions drain through the periodontal ligament. Many endodontic lesions are more prone to drain through cortical bone rather than through the periodontal ligament. It may be because of the nature of periradicular lesions which initially try to expand horizontally through cancellous bone and then progressing vertically. Evidence also suggests that endodontically treated teeth lack the same proprioceptive capability as endodontically untreated teeth so they may be subjected to greater occlusal forces. More forces could enhance the propagation of fracture lines along the root surface, resulting in more periodontal attachment loss. Also teeth associated with either root perforations or fractures appear to follow periodontal drainage routes whereas lesions of primarily pulpal origin seem to remain localized or drain through cortical bone. Many explanations are provided, firstly periodontal ligament may be resistant to bacterial insult of endodontic origin, or injuries originating through mechanical trauma are faintly recognized, causing a subtle attachment loss occurring secondary to routine endodontic disease. Another explanation could be that the main or accessory canals might not be the solo and most important route of communication and endodontic infection might also proceed along cervically located dentinal tubules.

A group of retrospective and experimental studies in the past demonstrated the effect of endodontic infection on periodontal status and healing. A series of retrospective studies performed on single rooted teeth of periodontitis prone patients correlated endodontic infection with periodontal status in terms of pocket depth and attachment loss. Teeth with periapical radiolucency demonstrated deeper pockets and more radio graphic attachment loss as compared to a healthy tooth. Non surgical periodontal treatment with horizontal defects depicted reduced mean pocket depth reduction and increased radio graphic attachment loss in teeth with periapical pathology in comparison with endodontically intact tooth. Even multi rooted teeth with periapical destruction in periodontitis prone patients exhibited significantly greater mean probing depth compared to teeth without periapical destruction. Mandibular molars with periapical destruction showed ≥ 3 mm horizontal furcation depth. In all these studies periodontal parameters of teeth (either root filled or with a periapical radiolucency) were compared with an endodontically intact tooth also present in the patients without any consideration of quality of obturation.

Research has denoted that endodontic treatment influences the periodontal healing and periodontal status of tooth.