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Periodontics I > Endo-Perio > Flashcards

Endo-Perio Flashcards

1
Q

what is the clinical presentation for endo/perio lesions

A
  • clinical scenarios involving both pulp and periodontium
  • acute
  • chronic
  • if related to recent traumatic or iatrogenic even, may manifest as pain with an abscess
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2
Q

what are the signs and symptoms of endo perio

A
  • deep periodontal pockets (approaching apex)
  • altered or negative response to pulp vitality tests
  • 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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3
Q

what is the etiology of endo perio

A
  • microbial contamination of the pulp and periodontium
  • related to periodontal and/or endodontic infection
  • related to trauma/iatrogenic factors
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4
Q

what is a primary endo infection

A

caries affecting pulp and subsequent periodontal involvement

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5
Q

what is a primary perio infection

A

periodontal destruction that then affects the pulp

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6
Q

what is associated with trauma/iatrogenic factors

A
  • root damage
  • external root resorption due to trauma
  • necrotic pulp from trauma then draining through periodontium
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7
Q

what can root damage present as

A
  • perforation of root, pulp chamber or furcation during preparation for root canal or post
  • root fracture or crack - iatrogenic or trauma
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8
Q

what is the bacterial profile for endo perio lesions

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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9
Q

what are the risk factors for endo perio that affect prognosis

A
  • advanced periodontal disease
  • trauma and iatrogenic events
  • anatomic factors: root grooves, furcation involvement, PFM crowns and active carious lesions
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10
Q

what are the prognoses for endo perio

A
  • hopeless- usually due to trauma/iatrogenic factors and leads to extraction
  • poor
  • favorable
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11
Q

how do you diagnose endo perio lesions

A
  • determine history of root damage: trauma, root canal treatment, post preparation
  • obtain radiographs and clinical examination: probing depths, perforation, fracture, root resorption
  • determine root anatomy and integrity
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12
Q

what is included in a full periodontal assessment

A
  • probing depths
  • attachment levels
  • bleeding/suppuration
  • mobility
  • percussion
  • vitality testing
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13
Q

need to determine if the tooth in question has:

A
  • root damage
  • no root damage
  • perio pt
  • non perio pt
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14
Q

what is the AAP classifications for end perio lesions with root damage

A
  • root fracture or crack
  • root canal or pulp chamber perforation
  • external root resorption
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15
Q

what are the grades for endo perio lesions without root damage in perio patients

A
  • grade 1: narrow, deep perio pocket on only 1 surface
  • grade 2: wide, deep periodontal pocket on only 1 surface
  • grade 3: deep periodontal pockets on more than 1 tooth surface
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16
Q

what are the grades for classification of endo perio lesions without root damage in non periodontitis patients

A
  • grade 1: narrow, deep periodontal pockets on only 1 surface
  • grade 2: wide, deep periodontal pocket on only 1 surface
  • grade 3: deep periodontal pockets on more than 1 tooth surface
17
Q

what are the physical routes of communication

A
  • apical foramen
  • lateral (accessory canals)
  • dentinal tubules
  • iatrogenic
18
Q

where are lateral canals found and the frequency

A
  • 28% in molar furcations
19
Q

osseous lesions of endodontic origin can be expected to heal:

A

completely

20
Q

osseous lesions of periodontic origin heal:

A

usually not reversible and depend on defect morphology for regeneration

21
Q

the greater the perio involvement the ____ the prognosis

A

worse

22
Q

what is the DDX for endo perio lesions

A
  • incomplete tooth fracture
  • developmental grooves
  • cervical enamel projections
  • periodontal abscess
23
Q

describe an incomplete tooth fracture

A
  • radiographic isolated vertical bone loss
  • teardrop radiolucency
  • can mimic both perio and endo symptoms
  • may be seen as an incomplete crown, root, or tooth fracture
24
Q

describe developmental grooves as a DDX

A
  • gingival palatal groove incidence of 4-8% on maxillary incisors
  • localized osseous lesion
  • peri pulpal line on radiograph
25
Q

describe cervical enamel projections as a DDX

A
  • various extent of CEPs from grade I to grade III which extend to furcation
  • incidence from 17-32% - much higher incidence in asian populations
26
Q

describe periodontal abscess as a DDX

A
  • symptoms consistent with periodontal abscess
  • radiographic is indicative of periodontal disease
  • acute abscess has better prognosis than chronic abscess
27
Q

what are the tx considerations with endo perio

A
  • perio evaluation is needed with endodontic evaluation to determine prognosis and treatment options
  • endo usually is done first
  • perio therapy follows endo
  • root resection or hemisection may be a viable alternative
28
Q
A

Periodontics I (13 decks)

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