e Flashcards
effect of periodontal disease on pulp
1) inflammatory alteration of pulp
2) pulp will not become necrotic from periodontal disease unless it reaches the apices
3) it appears that perio disease as well as period treatment have a negligible effect on the pulp
4) bone height was maintained equally well around root filled teeth and vital teeth
5) bone loss progresses at a faster rate for teeth with active periapical lesions
6)risk from a pulpless tooth must be negligible
endoperiod ideases
1) pulpal disease causing perio disease
2) peridontal disease causing pulpal disease
3) perforation
4) concurrent disease
5) etc.
endodontic lesions
1) primary endo
2) secondary perio
3) true combined
periodontitis associated with endodontic lesions
1) with root damage (prognosis is poor)
- root fracture
- perforation
- external root resorption
2) without root damage
- in periodontitis site (grade 1-3)
- in nonperiodontitis sire (grade 1-3)
grades
1 )grade 1: narrow deep pocket in one tooth
2) grade 2: wide deep pocket in one tooth
3) grade 3: deep pockets in > 1 tooth surface
wide 7mm PD on distal with narrow 12mm PD within
1) without root damage in periodontitis site, grade 2
endoperio diagnosis
1) history of symptoms
2) radiographic analysis
3) vitality testin
4) diagnostic probing
5) gutta percha tracing
6) percussion testing
history of symptoms
1) type of pain
- endo pain is more severe than perio pain
2) swelling?
3) location and duration
4) what elicits pain response
radiographic analysis
1) crestal bone loss
- tell you if there is a history of perio
2) apical radiolucency
3) deep caries
4) deep restoration
5) perforation
6) pins approaching pulp
7) furcation involvement
8) GP points
9) fracture?
vitality testin
1) measures neural response
2) most helpful with necrotic pulp
3) false positives with multi rooted teeth
periodontal etiology
1) wide broad pockets
endodontic eitiology
1) deep, narrow defect
2) no detectable calculus (deep)
3) may not have generalized periodontal pockets
4) deep, narrow defect can also be associated with palatal groove, vertical fracture, sinus tract, or enamel projection/pearl
percussion testing
1) doesnt really help distinguish between endo and perio
primary endo lesion
1) endo therapy first
2) avoid root instrumentation initially
3) reevaluate periodontal status (2-3 mo)
4) chronicity of periodontal lesion an issue
chronic perio lesion
1) prognosis depends on periodontal outcome
2) prognosis is poor if apex involved
3) consider extraction with implant or restorative
4) endo therapy first
perforations
1) pulpal floor or root
2) prevention is best
3) treatment can be to seal perforation
- MTA, GIC, amalgam, Ca hydroxide, etc
4) hemisection/root amputation (upper
5) extract
hemisection
1) cut teeth in half
2) cannot do it if both roots are BAD
3) short root trunks
4) make strategic sense
5) consider extraction with implant replacement option
6) concavity maintenance
resection
1) cannot do hemisection with maxillary molar
2) cut off distal root
3) adequate support on remaining roots
4) short root trunk
5) make sure roots are not fused at the apex
6) maintenance (end-tuft brush)
fractured cusp
1) prognosis depends on where the bottom of the fracture ends
2) evaluate extent of fracture and restorability
3) often do not require endo
- may require crown lengthening
cracked tooth/split tooth
1) tend to run mesiodistally
2) mand molars and max premolars
3) generally toward center of tooth
5) may have thermal sensitivity
6) Tx may include RCT or extraction
7) for split teeth, usually take out whole tooth
vertical root fracture
1) begin in the root
2) work from apical to coronal
3) extraction or removal of fractured root for a multirooted tooth
4) usually history of RCT
resorption
1) inflammatory and noninflammatory components initiates in the periodontium
- ex. trauma, ortho, bleaching
2) internal resorption starts with the pulp
- multinucleated giant cell activity
- affects internal dentin surface primarily
dentin hypersensitivity
1) sharp pain from stimuli
2) cannot be ascribed to any other form of dental defect or pathology
hydrodynamic theory
1) fluid flow evoked by stimuli
1) activates a-delta intradental nerves
3) mechanoreceptor response
4) larger tubes more associated with sensitivity
- typically a CEJ phenomenon
dentin hypersensitivity criteria
1) dentin needs to be exposed and dentin tubule system has to be opened and patent to the pulp
differential dignosis
1) caries
2) cracked teeth
3) new restoration
4) occlusal trauma
5) bleaching
6) others
management of DH
1) desensitizing toothpaste
- potassium nitrate will desensitize nerves
2) oxalate
3) arginine and calcium carbonate
4) fluoride
5) delivery trays
6) restorative materials
7) surgical root coverage
8) lasers
9) endodontic therapy
10) extraction
