Endodontics and Periodontics
Pulpal and periodontal diseases
are responsible for more than 50% of tooth mortality. Diagnosis is often challenging because these diseases have been primarily studied as separate entities and not as dynamic processes that show different phases as they evolve. It is important to understand such processes in order to institute appropriate treatment. During this dynamic inflammatory process, bone is replaced by granulation tissue, increasingly compromising the surrounding bone structure and therefore the long-term prognosis of the surgical site. One such class of bone defects
is well known as apicomarginal, and it is one of the main causes of endodontic surgery failures. However, it should be kept in mind that there are others types of disease that can mimic this type of process.
While the destructive effect of pulp necrosis on the periodontium is well documented, the effect of periodontal disease on the pulp is not so clear. Some authors have reported a close association between periodontal disease and inflammatory and degenerative changes in the pulp. Others did not find that relationship, rather that the pulp is affected only when the periodontal injury affects the apical foramen.
This chapter will try to explain these discrepancies by considering the fact that the pulp disease and the periodontal disease have the same methods of communication, and similar microbiological and inmuno-histopathological characteristics.