The morphological and functional relationship between dental pulp and periodontal tissue in the aspect of endo-perio lesions

Abstract

Relevance. The growing prevalence of combined endo-perio lesions (EPL) attracts the interest of researchers. Insufficiently covered in the scientific literature, issues of the anatomical and functional relationship between periodontal tissues and dental pulp, the lack of an algorithm for diagnosis and treatment of EPL determine the need for their research. The study aimed to arrange the available data on the morpho-functional aspects of the relationship between dental pulp and periodontal tissues and their features that determine the p athogenesis of EPL.Materials and methods. The study found 2875 publications, presented in the international electronic scientific databases PubMed, Google Search, Embase, Web of Science, ScienceDirect, SciELO and eLibrary. Following the inclusion and non-inclusion criteria, we selected 52 publications, which included the results on studying the structure and function of periodontal tissues, roots and pulp of teeth in the aspect of EPL development. The methodology of this study meets the criteria for systematic reviews and meta-analyses (PRISMA).Results. In EPL lesions, inflammation is maintained by an infection, which persists in the additional root canals and dentinal tubules and the periodontal pocket. Prevention of the formation and elimination of infection foci in the root canal system of the tooth, periapical tissues and periodontal pockets is the basis for EPL prevention and treatment. At the same time, there are no diagnostic and therapeutic algorithms, which allow timely detection of EPL and adequate treatment, depending on the primary lesion of pulpal and periodontal tissues and individual characteristics of the patient. The structure specifics of roots, pulp, cementum, periodontium and alveolar bone are described. The characteristic features of blood supply and innervation of the pulpal and periodontal tissues are presented. Promising areas of scientific research in EPL prevention and treatment are identified.Conclusion. Tooth pulp and periodontal tissues are closely related morphologically and functionally. They are principally connected through the apical foramina and additional canals. Bacterial infection can also penetrate the pulp and periodontal tissues from the infected root canal system of the tooth through the dentinal tubules of the tooth root.