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Chogle SMA, Goodis HE, Kinaia BM. Pulpal and periradicular response to caries: current management and regenerative options. Dent Clin North Am 2013; 56:521-36. [PMID: 22835535 DOI: 10.1016/j.cden.2012.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The pulp-dentin complex is a strategic and dynamic barrier to various insults that plague the dentition. Researchers have yet to understand the complete potential of this shifting junction and its components. The most common cause of injury to the pulp-dentin complex is carious breakdown of enamel and dentin. In recent years, there has been a change in restorative management of caries. The emphasis is on strategies to preserve dentin and protect the pulp. This article provides a brief review of the effect of caries on the pulp, of subsequent events on the periradicular tissues, and of current understanding of treatment modalities.
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Affiliation(s)
- Sami M A Chogle
- Endodontics Department, The Boston University Institute for Dental Research and Education, PO Box 505097, Dubai Healthcare City, Dubai, United Arab Emirates.
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52
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Corbet E, Smales R. Oral diagnosis and treatment planning: part 6. Preventive and treatment planning for periodontal disease. Br Dent J 2012; 213:277-84. [PMID: 22996473 DOI: 10.1038/sj.bdj.2012.837] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2012] [Indexed: 11/09/2022]
Abstract
A high level of sustained personal plaque control is fundamental for successful treatment outcomes in patients with active periodontal disease and, hence, oral hygiene instructions are the cornerstone of periodontal treatment planning. Other risk factors for periodontal disease also should be identified and modified where possible. Many restorative dental treatments in particular require the establishment of healthy periodontal tissues for their clinical success. Failure by patients to control dental plaque because of inappropriate designs and materials for restorations and prostheses will result in the long-term failure of the restorations and the loss of supporting tissues. Periodontal treatment planning considerations are also very relevant to endodontic, orthodontic and osseointegrated dental implant conditions and proposed therapies.
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Affiliation(s)
- E Corbet
- The University of Hong Kong, Hong Kong, China
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Zuza EP, Vanzato Carrareto AL, Pontes AEF, Brunozzi M, Pires JR, Toledo BEC. Chronic periodontal disease may influence the pulp sensitivity response: clinical evaluation in consecutive patients. ISRN DENTISTRY 2012; 2012:246875. [PMID: 22577567 PMCID: PMC3335179 DOI: 10.5402/2012/246875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 02/07/2012] [Indexed: 11/23/2022]
Abstract
Purpose. The aim of the present study was to evaluate the clinical response of the pulp in teeth with chronic periodontitis. Methods. Consecutive patients who had been admitted to the Clinics of Periodontology and fulfilled the criteria of inclusion were enrolled from January to December 2007. Ninety-eight single-root teeth from 27 patients with chronic periodontitis were evaluated clinically with regard to clinical attachment level (CAL), probing depth (PD), and gingival recession (REC). After periodontal measurements, Pulpal Sensitivity (PS) was evaluated with the use of a cooling stimulus test. Data was analyzed with Student's t test and contingency C coefficient. Results. Teeth that responded positively to PS test presented lower values of CAL (7.8 ± 2.8 mm), PD (5.0 ± 2.3 mm), and REC (2.8 ± 1.8 mm) in comparison to those that responded negatively (CAL = 12.0 ± 2.2 mm; PD = 7.9 ± 1.6 mm; REC = 4.1 ± 2.4 mm) (P < 0.01, Student's t test). In addition, significant correlations were observed between PS and periodontal parameters. Conclusions. Within the limits of this study, it could be suggested that the progression of periodontitis may significantly influence the negative pulpal response.
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Affiliation(s)
- Elizangela Partata Zuza
- Department of Master of Dental Science, School of Dentistry, Educational Foundation of Barretos (UNIFEB), Avenide Roberto Frade Monte 389, 14783-226, Barretos, SP, Brazil
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Narang S, Narang A, Gupta R. A sequential approach in treatment of perio-endo lesion. J Indian Soc Periodontol 2011; 15:177-80. [PMID: 21976845 PMCID: PMC3183672 DOI: 10.4103/0972-124x.84390] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 06/02/2011] [Indexed: 12/02/2022] Open
Abstract
The success of a combined periodontal and endodontic lesion depends on the elimination of both of these disease processes. In the case of a combined endo-perio lesion, the endodontic therapy results in healing of the endodontic component of involvement while the prognosis of tooth would finally depend on the healing of the periodontal structures. This case report evaluates the efficacy of bioactive glass in the management of furcation defect associated with an endo-perio lesion in a right mandibular first molar. A 22-year-old male patient with an endo-perio lesion in the right mandibular first molar was initially treated with endodontic therapy. Following the endodontic treatment, the furcation defect was treated using bioactive glass in a putty form. At the end of 9 months, there was a gain in the clinical attachment level and reduction in probing depth. Radiographic evidence showed that there was a significant bony fill.
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Affiliation(s)
- Sumit Narang
- Department of Periodontology, People's College of Dental Science, Bhopal, Madhya Pradesh, India
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55
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Nirola A, Grover S, Sharma A, Kaur D. Pulpal perio relations: Interdisciplinary diagnostic approach - I. J Indian Soc Periodontol 2011; 15:80-2. [PMID: 21772729 PMCID: PMC3134055 DOI: 10.4103/0972-124x.82257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Accepted: 01/12/2010] [Indexed: 11/07/2022] Open
Abstract
Lesions of pulpal and periodontal origin may perpetuate from either the infections of dental pulp or periodontium or alveolar bone. This review focuses on interdisciplinary diagnostic approach towards lesions of periodontal or endodontic origin.
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Affiliation(s)
- Ashutosh Nirola
- Department of Periodontics and Implantology, Luxmibai Institute of Dental Sciences, Patiala, Punjab, India
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Moreira CHC, Zanatta FB, Antoniazzi R, Meneguetti PC, Rösing CK. Criteria adopted by dentists to indicate the extraction of periodontally involved teeth. J Appl Oral Sci 2009; 15:437-41. [PMID: 19089175 PMCID: PMC4327266 DOI: 10.1590/s1678-77572007000500012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Accepted: 08/21/2007] [Indexed: 11/22/2022] Open
Abstract
When dealing with patients with periodontal disease of variable severities, dentists must often choose between treating and restoring the involved tooth or indicating its extraction. Different criteria have been adopted in this decision-making process. The purpose of this study was to evaluate the criteria adopted by dentists to indicate the extraction of teeth with periodontitis. Dentists were interviewed at their private practices in three cities of the state of Rio Grande do Sul, Brazil. The evaluated criteria included severity of attachment loss, tooth mobility, furcation involvement, prosthetic planning, periodontal-endodontic lesion, possible systemic involvement due to the presence of periodontitis, referral to a periodontist for evaluation, radiographic bone loss greater than 50%, presence of extensive caries, socio-economic and cultural status of the patient, among others. The most often adopted criteria to indicate the extraction of periodontally affected teeth were the presence of mobility (37.5%), severity of attachment loss (24.3%) and radiographic bone loss greater than 50% (21.2%). The results of the present study demonstrated the difficulties faced by dentists to indicate the extraction of teeth with severe attachment loss, in addition to the establishment of an adequate prognosis. Aspects associated with the past disease were still the most often reported to indicate the extraction of teeth for periodontal reasons.
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57
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Sunitha V R, Emmadi P, Namasivayam A, Thyegarajan R, Rajaraman V. The periodontal - endodontic continuum: A review. J Conserv Dent 2008; 11:54-62. [PMID: 20142886 PMCID: PMC2813095 DOI: 10.4103/0972-0707.44046] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2007] [Revised: 09/20/2007] [Accepted: 10/04/2007] [Indexed: 11/08/2022] Open
Abstract
Periodontal therapy deals with many aspects of the supporting structures, including the prevention and repair of lesions of the gingival sulcus. 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 years. This paper aims at presenting a comprehensive review of several aspects of perio-endo lesions.
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Affiliation(s)
- Raja Sunitha V
- Department of Periodontics, Meenakshiammal Dental College and Hospital, Alapakkam Road, Maduravoyal, Chennai, India
| | - Pamela Emmadi
- Department of Periodontics, Meenakshiammal Dental College and Hospital, Alapakkam Road, Maduravoyal, Chennai, India
| | - Ambalavanan Namasivayam
- Department of Periodontics, Meenakshiammal Dental College and Hospital, Alapakkam Road, Maduravoyal, Chennai, India
| | - Ramakrishnan Thyegarajan
- Department of Periodontics, Meenakshiammal Dental College and Hospital, Alapakkam Road, Maduravoyal, Chennai, India
| | - Vijayalakshmi Rajaraman
- Department of Periodontics, Meenakshiammal Dental College and Hospital, Alapakkam Road, Maduravoyal, Chennai, India
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Tai TF, Chiang CP, Lin CP, Lin CC, Jeng JH. Persistent endodontic lesion due to complex cementodentinal tears in a maxillary central incisor—a case report. ACTA ACUST UNITED AC 2007; 103:e55-60. [PMID: 17449287 DOI: 10.1016/j.tripleo.2006.12.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Revised: 12/03/2006] [Accepted: 12/14/2006] [Indexed: 11/15/2022]
Abstract
The cementodentinal tear is rarely detected by noninvasive procedures owing to its clinical picture simulating a root fracture or a periodontal or endodontic lesion. We present a case of complex cementodentinal tears in a 79-year-old woman who presented a repeated swelling at the labial mucosa of the left maxillary central incisor for 6 months. Periapical radiographs demonstrated a vertical radiolucent fracture line extending from the root apex along the mesial aspect of the root to near the middle portion of the root of the left maxillary central incisor. Because endodontic re-treatment failed to cure the disease, periapical surgery was performed, and 2 fractured U-shaped root fragments around the apical root surface were removed. Histologic examination showed that the 2 fractured root fragments were composed mainly of the dentin covered by a thin layer of the cementum and overlying periodontal ligament tissue, suggesting cementodentinal tears. A swelling recurred 8 months after the initial operation. Therefore, a second periapical surgery was performed. Although no obvious fracture line was observed around the root surface, the second surgery did not cure the disease, either. A persistent small swelling was noted at the alveolar mucosa of the affected tooth during the follow-up. We conclude that although a cementodentinal tear can be detected by a careful radiographic examination, its clinical outcome is not predictable by surgical removal only.
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Affiliation(s)
- Tseng-Fang Tai
- Department of Endodontics, National Taiwan University Hospital and School of Dentistry, College of Medicine, Taipei, Taiwan
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59
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ROTSTEIN ILAN, SIMON JAMESH. The endo-perio lesion: a critical appraisal of the disease condition. ACTA ACUST UNITED AC 2006. [DOI: 10.1111/j.1601-1546.2006.00211.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Siqueira JF. Reaction of periradicular tissues to root canal treatment: benefits and drawbacks. ACTA ACUST UNITED AC 2005. [DOI: 10.1111/j.1601-1546.2005.00134.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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63
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64
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Affiliation(s)
- Gary C Armitage
- Department of Stomatology, School of Dentistry, University of California, San Francisco, California, USA
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65
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Affiliation(s)
- Esmonde F Corbet
- Periodontology, Faculty of Dentistry, University of Hong Kong, Hong Kong, China
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66
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Affiliation(s)
- Gary C Armitage
- Department of Stomatology, School of Dentistry, University of California, San Francisco, California, USA
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