Endo-Perio Flashcards
what is the clinical presentation for endo/perio lesions
- clinical scenarios involving both pulp and periodontium
- acute
- chronic
- if related to recent traumatic or iatrogenic even, may manifest as pain with an abscess
what are the signs and symptoms of endo perio
- 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
what is the etiology of endo perio
- microbial contamination of the pulp and periodontium
- related to periodontal and/or endodontic infection
- related to trauma/iatrogenic factors
what is a primary endo infection
caries affecting pulp and subsequent periodontal involvement
what is a primary perio infection
periodontal destruction that then affects the pulp
what is associated with trauma/iatrogenic factors
- root damage
- external root resorption due to trauma
- necrotic pulp from trauma then draining through periodontium
what can root damage present as
- perforation of root, pulp chamber or furcation during preparation for root canal or post
- root fracture or crack - iatrogenic or trauma
what is the bacterial profile for endo perio lesions
- generally there is not a specific microbial profile for the EPL
- no major difference between lesion of endodontic origin vs periodontal origin
what are the risk factors for endo perio that affect prognosis
- advanced periodontal disease
- trauma and iatrogenic events
- anatomic factors: root grooves, furcation involvement, PFM crowns and active carious lesions
what are the prognoses for endo perio
- hopeless- usually due to trauma/iatrogenic factors and leads to extraction
- poor
- favorable
how do you diagnose endo perio lesions
- 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
what is included in a full periodontal assessment
- probing depths
- attachment levels
- bleeding/suppuration
- mobility
- percussion
- vitality testing
need to determine if the tooth in question has:
- root damage
- no root damage
- perio pt
- non perio pt
what is the AAP classifications for end perio lesions with root damage
- root fracture or crack
- root canal or pulp chamber perforation
- external root resorption
what are the grades for endo perio lesions without root damage in perio patients
- 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
what are the grades for classification of endo perio lesions without root damage in non periodontitis patients
- 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
what are the physical routes of communication
- apical foramen
- lateral (accessory canals)
- dentinal tubules
- iatrogenic
where are lateral canals found and the frequency
- 28% in molar furcations
osseous lesions of endodontic origin can be expected to heal:
completely
osseous lesions of periodontic origin heal:
usually not reversible and depend on defect morphology for regeneration
the greater the perio involvement the ____ the prognosis
worse
what is the DDX for endo perio lesions
- incomplete tooth fracture
- developmental grooves
- cervical enamel projections
- periodontal abscess
describe an incomplete tooth fracture
- 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
describe developmental grooves as a DDX
- gingival palatal groove incidence of 4-8% on maxillary incisors
- localized osseous lesion
- peri pulpal line on radiograph
describe cervical enamel projections as a DDX
- various extent of CEPs from grade I to grade III which extend to furcation
- incidence from 17-32% - much higher incidence in asian populations
describe periodontal abscess as a DDX
- symptoms consistent with periodontal abscess
- radiographic is indicative of periodontal disease
- acute abscess has better prognosis than chronic abscess
what are the tx considerations with endo perio
- 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
