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Periodontitis in combination with endodontic lesions

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Endodontic-periodontic lesions are distinguished from periodontic-endodontic and combined lesions.
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Endodontic-periodontal lesion

  1. The periodontal lesion is preceded by pulp necrosis
  2. An originally apical lesion penetrates into the oral cavity through the periodontium and causes destruction of the bone and surrounding tissue
  3. Bacteria from an infected pulp can gain access to the surroundings through subsidiary pulp channels and may, for example, cause furcation involvement.

Periodontic-endodontic lesion

  1. Existing periodontitis can lead through pockets with bone loss to the pulp becoming infected and necrotic
  2. The infection can take place through secondary channels or through the apical foramen with advancing bone loss
  3. Another cause for this lesion can be that cementum is lost due to scaling and dentin channels are exposed which can bring the infection into the tooth.

Combined lesions

  1. Combined lesions occur at teeth where apical periodontitis and marginal periodontitis have developed independently of one other.
(Blieden 1999; Carranza et al. 2006)


  • Blieden, T. M. (1999): Tooth-related issues. In: Ann. Periodontol. 4 (1), S. 91–97. DOI: 10.1902/annals.1999.4.1.91
  • Carranza, Fermin A.; Newman, Michael G.; Takei, Henry H.; Klokkevold, Perry R. (2006): Carranza's clinical periodontology. 10th ed. St. Louis, Mo.: Saunders Elsevier