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PERIO I > endo perio > Flashcards

endo perio Flashcards

1
Q

Clinical Presentation for Endo/Perio Lesions
* Clinical scenarios involving?
* time frames?
* If related to recent traumatic or iatrogenic event,
may manifest as?

A
  • Clinical scenarios involving both pulp and
    periodontium
  • Acute
  • Chronic
  • If related to recent traumatic or iatrogenic event,
    may manifest as PAIN with an Abscess
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2
Q

Signs and Symptoms of endo perio
* periodontal pockets?
* pulp vitality tests?

A
  • Deep periodontal pockets (approaching apex)
  • Altered or negative response to pulp vitality
    (sensibility) tests
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3
Q

Signs and Symptoms of endo perio
* Bone resorption?
* pain?
* Exudate?
* mobility?
* Sinus tract?
* Crown and gingival color?

A
  • Bone resorption in apical or furcation region
  • Spontaneous pain or pain on palpation/percussion
  • Exudate
  • Tooth mobility
  • Sinus tract
  • Crown and gingival color changes
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4
Q

endo perio etiology

A
  • Microbial contamination of the pulp and
    periodontium
    A. Related to periodontal &/or endo infection
    B. Related to trauma/Iatrogenic factors
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5
Q

Perio/Endo infection
* Primary Endodontic?
* Primary Periodontic?
* ‘Combined’ lesion?

A
  • Primary Endodontic: caries affecting pulp and subsequent periodontal involvement
  • Primary Periodontic: periodontal destruction that then affects the pulp
  • True ‘Combined’ lesion
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6
Q

Associated with Trauma/Iatrogenic Factors
* Root damages?
* External root resorption?
* Necrotic pulp?

A
  • Root damage
    1. * Perforation of root, pulp chamber or furcation (during preparation for root canal or post)
    1. * Root fracture or crack (iatrogenic or trauma)
  • External root resorption (due to trauma)
  • Necrotic pulp (from trauma then draining through
    periodontium)
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7
Q

Bacterial Profile of EPL

A
  • Generally, there is not a specific microbial profile
    for the EPL
  • No major difference between lesion of endodontic
    origin vs. periodontal origin
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8
Q

Risk Factors (affect prognosis) of EPL
* perio?
* Trauma and iatrogenic?
* Anatomic factors?

A
  • Advanced periodontal disease
  • Trauma and iatrogenic events
  • Anatomic factors:
    1. * Root grooves
    1. * Furcation involvement
    1. * PFM crowns and active carious lesions
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9
Q

why are all lesions with perio/enod now called EPL

A

determining primary source is not relevant for treatment as both root canal and periodontal tissues require treatment

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10
Q

Diagnosis of EPL
Base treatment options on?
* types of prognosis?

A

Base treatment options on presenting disease status
* Determine prognosis
* Hopeless (usually due to trauma/iatrogenic factors and leads to extraction)
* Poor
* Favorable

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11
Q

Diagnosis EPL
1. hx of root damage?
2. Obtain?
3. Determine root?

A
  1. Determine history (if known) of root damage
    * trauma, root canal treatment, post preparation
  2. Obtain radiographs and clinical examination
    * probing depths, perforation, fracture, root resorption
  3. Determine root anatomy and integrity
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12
Q

No evidence of root damage with EPL, do what now?
Perform? components of this?

A

Perform full periodontal assessment
* Probing depths
* Attachment levels
* Bleeding/suppuration
* Mobility
* Percussion
* Vitality testing

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13
Q

EPL Assessment (for 2017 classification)
Need to determine if tooth in question has?

A

Need to determine if tooth in question has
a) Root damage (and if so, what type?)
b) No root damage: Periodontitis patient or Non periodontitis patient

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14
Q

EPL root damage types

A

sw

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15
Q

EPL without root damage classes/grades

A
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16
Q

Perio-Endo
* Difficulty in?

A
  • Difficulty in Diagnosis
  • Difficulty in Treatment
  • Difficulty in Determining Prognosis
17
Q

Physical Routes of
Communication btwn endo/perio

A
  • Apical Foramen
  • Lateral (Accessory) Canals
  • Kirkham (75) found 28% and Rubach (65) found 45% on single-rooted teeth
  • Gutman (78) found 28% in molar furcations**
  • Dentinal Tubules (Controversial)
  • Iatrogenic
18
Q

 Dentinal Tubules as route of comm
 Seltzer (67)?
 Adriaens (88)?

A

 Seltzer (67) found 21% incidence of inflammation in pulp and periodontium
 Adriaens (88) demonstrated bacteria in dentinal tubules (false positives in controls may indicate contamination)

19
Q

Healing Potential
 Osseous lesions of endodontic origin?
 Osseous lesions of periodontic origin?
 The greater the periodontic involvement effect on prognosis?

A

 Osseous lesions of endodontic origin can be expected to heal completely
 Osseous lesions of periodontic origin are usually not reversible and depend on defect morphology for regeneration
 The greater the periodontic involvement, the worse the prognosis

20
Q

Differential Diagnosis for EPL

A

 Incomplete Tooth Fracture
 Developmental Grooves
 Cervical Enamel Projections
 Periodontal Abscess

21
Q

 Incomplete Tooth Fracture
 Radiographic?
 Can mimic symptoms of?
 May be seen as?

A

 Radiographic isolated vertical bone loss
 “Teardrop” radiolucency
 Can mimic both periodontal and endodontic symptoms
 May be seen as an incomplete crown, root, or tooth fracture

22
Q

 Developmental Grooves
 Gingival palatal groove incidence max I?
 localized?
 radiograph?

A

 Gingival palatal groove incidence of 4-8% on maxillary incisors
 Localized osseous lesion
 “Peri-pulpal” line on radiograph

23
Q

 Cervical Enamel Projections
 extent/grades?
 Incidence? demographic?

A

 Various extent of CEPs from grade I to grade III (which extend into furcation)
 Incidence from 17-32% (much higher incidence in Asian populations)

24
Q

 Periodontal Abscess
 Symptoms consistent with?
 Radiograph is indicative of?
 Acute/chronic abscess prognosis?

A

 Symptoms consistent with periodontal abscess
 Radiograph is indicative of periodontal disease
 Acute abscess has better prognosis than chronic abscess

25
Q

Treatment Considerations for perio abcesses
 Periodontal/ endo evaluations?
 what usually is done first?
 Periodontal therapy?
 Root resection or hemisection?

A

 Periodontal evaluation is needed with endodontic evaluation to determine prognosis and treatment options
 Endodontics usually is done first
 Periodontal therapy follows endo
 Root resection or hemisection may be
viable alternative

PERIO I (13 decks)

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