The relationship between periodontal and pulpal disease was first described by Simring and Goldberg in 1964.Since then this term has been used to describe lesions due to inflammatory products found in varying degrees in both the periodontium and pulpal tissues.
The differential diagnosis of perio endo lesions has become increasingly important as the demand for complicated restorative work has grown. Neither periodontal nor endodontic treatment can be considered in isolation, clinically, as they are closely related and this treatment must influence the diagnosis and treatment. The controversy concerning the effect of periodontal disease pulp ranges between those who believe that pulpitis or pulp necrosis or both can occur as a result of periodontal inflammation to those who state categorically that pulpal changes are independent of the status of the periodontium.
There are four types of perio-endo lesions and they are classified [1] due to pathogenesis:
- Endodontic lesions- an inflammatory process in the periodontal tissues resulting from noxious agents present in the root canal system of the tooth [Figure 1]a and b
Figure 1: a and b: Endodontic lesion - Periodontal lesions-an inflammatory process in the pulpal tissues resulting from accumulation of dental plaque on the external root surfaces [Figure 2]a and b
Figure 2: a and b: Periodontic lesion - True-combined lesions- both an endodontic and periodontal lesion developing independently and progressing concurrently which meet and merge at a point along the root surface [Figure 3]a and b
Figure 3: a and b: True-combined lesion - Iatrogenic lesions- usually endodontic lesions produced as a result of treatment modalities