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1、Periodontology2000,Vol.34,2004,165–203Copyright#BlackwellMunksgaard2004PrintedinDenmark.AllrightsreservedPERIODONTOLOGY2000Diagnosis,prognosisanddecision-makinginthetreatmentofcombinedperiodontal-endodonticlesionsIlanRotstein&JamesH.S.SimonThepulpandperiodontiumareintimatelyrel
2、ated.AsScanningelectronmicroscopicstudieshavethetoothdevelopsandtherootisformed,threemaindemonstratedthatdentinexposureattheCEJavenuesforcommunicationarecreated:dentinaloccurrsin18%ofteethingeneralandin25%oftubules,lateralandaccessorycanals,andtheapicalanteriorteethinparticular
3、(132).Furthermore,theforamen.sametoothmayhavedifferentCEJcharacteristicswithdentinexposureononesidewhiletheothersidesarecoveredwithcementum(162).ThisareaAnatomicconsiderationsbecomesimportantinassessingtheprogressionofendodonticpathogens(Fig.2),aswellastheeffectofrootscalingand
4、planingoncementumintegrity,andDentinaltubulesbleaching-inducedrootresorptionfollowingtheuseExposeddentinaltubulesinareasofdenudedof30%hydrogenperoxide(50,78,153,154).cementummayserveascommunicationpathwaysOtherareasofdentinalcommunicationmaybebetweenthepulpandperiodontalligamen
5、t(Fig.1).throughdevelopmentalgrooves,bothpalatogingivalExposureofdentinaltubulesmayoccurduetodevel-andapical(173).opmentaldefects,disease,orperiodontalproce-dures.Intheroot,dentinaltubulesextendfromtheLateralandaccessorycanalspulptothedentinocementaljunction(73).Theyrunarelativ
6、elystraightcourseandrangeinsizefrom1toLateralandaccessorycanalsmaybepresentany-3mmindiameter(126).Thediameterofthetubuleswherealongtheroot(Fig.3).Theirprevalenceanddecreaseswithageorasaresponsetoacontinuouslocationhavebeenwelldocumentedinbothanimallowgradestimulibytheapposition
7、ofhighlyminer-andhumanteeth(26,44,69,101,115,141,155).alizedperitubulardentin.ThenumberofdentinalItisestimatedthat30–40%ofallteethhavelateraltubulesvariesfromapproximately8,000attheden-oraccessorycanalsandthemajorityofthemaretinocementaljunctionto57,000persquaremilli-foundinthe
8、apicalthirdoftheroot(73).DeDeusmeteratthepulpalend(126