Endo Perio

Question 1

What are dental and perio disease derived from?

Answer 1

Ectomesenchymal tissue

Question 2

How do accessory canals form?

Answer 2

Ectomesenchymal tissue gets trapped

Question 3

Will lateral canals exposure in endo perio always cause perio-endo?

Answer 3

• Rare that they exist

- Rare that they get involved in perio-endo even if they do exist

Question 4

T/F dentinal tubules can be a pathway for perio-endo

Answer 4

F

very rare

Question 5

What was found in the bone level of endodontically treated teeth vs vital teeth?

Answer 5

-Very little difference

Question 6

What are the signs of endo-perio lesions?

Answer 6

• Negative pulp test
• PA lesion visible
• Sinus tracts coronally into sulcus
• Deep, narrow, probing defect
• Sinus tract may mimic perio abscess

Question 7

How long does it take the pocket to resolve in endo-perio lesions after treatment? What should you do if pocket has only partially resolved?

Answer 7

4-6weeks

If partially resolved debridement

Question 8

What are the signs/symptoms of vertical root fracture?

Answer 8

• Pain usually mild or moderate intensity
• Pain on pressure on mastication is common, but mild
• Broad based swelling in MID root (rather than apex)
• May have sinus tract (but closer to gingival margin than apex)

-If two sinus tracts (one buccal, one lingual) almost definitely a vertical root fracture–>extends all the way through tooth

Radiographically: may have diffuse radiolucent halo or J-shaped defect (more buccal or lingual vs perio/endo lesion that is commonly in furcations)

Question 9

What is the pre-disposing factor for vertical root fractures?

Answer 9

Endo treatment (excessive dentine removal at CEJ, heavy forces during lateral condensation, post placement)

• Occlusal forces
• Anatomical (long buccal lingually, small mesio distally)

Question 10

What should you try to do to diagnose vertical root fractures

Answer 10

Visualise:

• Remove restoration
• Retract gingiva
• Flap

Question 11

What should you do if pt presents with endodontically treated tooth with radiolucency present?

Answer 11

• Mesial shift
• Pulp test
• Put GP point into sinus tract if present
• Can also confirm with cone beam to determine whether missed canal or vertical root fracture

Question 12

What should you be wary of if bone loss extends past apex of tooth?

Answer 12

• Pulp test

- The pulp migth not necessarily get involved straight away–>in which case only perio treatment

Question 13

What is a true combined lesion?

Answer 13

• Pre-existing perio and pre-existing endo extend to combine with each other
• The two become clincally indistinguishable

Question 14

How should you treat a combined lesion?

Answer 14

• Most pts will opt to have XO due to guarded prognosis
• But if treat then treat endo first and concurrent perio (i.e. extirpate and then treat both at same time)–>need endo clean for good outcome and to prevent bacteria travelling through dentinal tubules to perio area after cementum removed from scaling
• Assess 3months after extirpation and scaling, if healing response favourable then complete endo
• If unfavourable, consider whether continued perio treatment is justified and if multi-rooted consider hemisection or root resection

-Arrange SPT

Question 15

What root in upper molars is most likely to be affected by perio/endo lesions?

Answer 15

*Note upper molar most likely root to be affected is MB root