Healing of Periapical Lesions - Source of Infection

Source of Infection

Although periapical changes will be in response to pulpal changes the majority of the time, it is still important to determine the disease process sequence. When the disease process is of pulpal origin, the pulpal infection and necrosis may drain not only through the apical foramen, but also through an accessory canal, which may present radiographically as a periradicular or furcation radiolucency. This may further lead to furcal involvement through loss of clinical attachment and alveolar bone. A cursory clinical examination and radiographic analysis can easily lead the clinician off the right course and pulpal involvement might be overlooked when the tooth is asymptomatic. Similarly, a periodontal abscess may very well appear to be pulpal in origin, when in fact it is not. Notwithstanding the tissue of origin, though, when it is determined that there is a pulpal involvement to the periodontal lesion, the endodontic infection should be controlled prior to beginning definitive management of the periodontal lesion, especially when regenerative or bone grafting techniques are planned.