COMBINED PERIODONTAL ENDODONTIC INFECTIONS

When a tooth is involved in a Combined Periodontal-Endodontic Infection (CPEI) there is a communication between an infected tooth pulp (the internal soft tissue structure of a tooth) and the space along the side of a tooth, or periodontium (the soft tissue support structure of the tooth roots).

A tooth is a naturally enclosed structure with an internal soft tissue component that we call the pulp which is made up basically of connective tissue, blood vessels and nerves. The pulp communicates with the body through small openings in the roots – most typically in the root tips – that we call the root canal openings. Root canal treatment is designed to remove any dead tissue from the diseased root canal space and seal off the openings in the roots. Periodontal disease involves bone loss and communications along the sides of the roots of the teeth. Periodontal problems are typically treated with cleaning up the diseased tissue, controlling the bacterial environment, and grafting the tissues and/or bone if there is significant loss.

When there is a communication between an endodontic/root canal problem, and a periodontal/gum-disease problem, I would evaluate the severity, treatability, and the relative importance of the tooth in the dental scheme. Treatment may be recommended to try to save the tooth if reasonable for the individual patient.

I am absolutely not opposed to trying to save teeth – even if treatment may be considered heroic. However, it is my prejudice as a dental implant practitioner, that in many cases we are much better off replacing such a tooth with a dental implant early on. Treatment of advanced CPEI has shown low success rates and the very action of treatment often results in further bone loss and can ultimately compromise a dental implant plan. Built into my prejudice is the knowledge that dental implants have a comparatively excellent long term success rate and long term treatment stability.

If you have a tooth that has a diagnosis of a Combined Periodontal-Endodontic Infection – seek out several opinions. Read up on the success rates and make your best educated decision moving forward.

(Reference: Inside Dentistry April 2018 Pg. 38)