06 Ortho, Endo and Restorative considerations

Question 1

Benefits of Ortho in relationship with perio

Answer 1

-Correct crowding
-Uprighting
These provide better access for plaque removal and can correct/align the occlusal forces properly
-can create a more favorable crown:root ratio (intrusion)

Question 2

What perio must be done before ortho therapy?

Answer 2

-periodontal therapy must remove deposits and resolve marginal inflammation prior to ortho therapy

Question 3

What are the types of Perio-Endo Lesions?

Answer 3

1. Endodontic problem with fistulization from the tooth’s apex. Pulpal infection can spread through accessory canals along root surface including furcation.
2. A periodontal pocket can deepen to the apex and secondarily involve the pulp
3. periodontal pocket can infect the pulp thru an accessory canal and this can result in a periapical lesion
4. Two independent lesions, periapical and periodontal can coexist and eventually fuse

Question 4

Prognosis of combined perio-endo lesions:

Answer 4

• endodontic therapy is highly predictable
• ultimately the prognosis depends on the ability to manage the pd defect
• chronic pd component decreases prognosis
• Acut pd component increases prognosis

Question 5

What is the treatment for combined perio-endo lesions?

Answer 5

• endodontic therapy is performed first
• removal of plaque and calculus
• Tooth evaluated: check if residual pocket and/or boney defect is present. and
• Periodontal therapy: osseous resentive surgery, and/or regeneration (bone grafting, barrier membrane)