Authors: Hiatt WH.
Title: Pulpal periodontal disease.
Journal: J Periodontol
Date: Sep 1977
Citation: 48(9):598-609
Category: Endodontic-Periodontal Relationships
Evidence-based Ranking: 5
Purpose/Objective: To identify common etiologic agents and relate them to duration, pathogenesis, diagnosis and treatment of this lesion.

Discussion: The pulpal-periodontal lesions are 1) pulpal lesions with secondary periodontal disease of short duration 2) pulpal lesions with secondary periodontal disease of long duration 3) periodontal lesions of short duration with secondary pulpal disease 4) periodontal lesions of long duration with secondary pulpal disease 5) periodontal lesions treated by hemisection or root amputation 6) complete and incomplete crown-root fractures 7) independent pulpal and periodontal lesions which merge into a combined lesion 8) pulpal lesions which evolve into periondontal lesions following treatment and 9) periodontal lesions that evolve into pulpal lesions following treatment. In treating pulpal-periodontal disease, it is important to determine if the lesion is from pulpal or periodontal infection and to determine the duration of the disease. Both pulpal and periodontal lesions of short duration are often reversed when the cause is eliminated. Also, periodontal lesions of short duration from pulpal infection often close following endodontic treatment. When the pulpal-periodontal lesion is from periodontal disease of long duration, endodontic therapy while necessary will not correct the periodontal condition. In these cases, periodontal management requires surgical correction in addition to controlling the cause of the disease. Endodontic therapy often successfully treats periodontal furcations of short duration but if the cause is periodontal in origin, hemisection or root amputation is necessary to manage the problem.

ReviewerÂ’s comments: A classification system is proposed for pulpal-periodontal lesions and suggestions for therapy are discussed.