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Endotontics > Endo / Perio Connection > Flashcards

Endo / Perio Connection Flashcards

1
Q

4 major endo- perio connection

A
  1. lateral canals
  2. dentinal tubules
  3. apical foramina
  4. iatrogenic perforation
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2
Q

lateral canals?

A

while migrating apically and forming the rooth the epithelial sheath of hertwig

  • can have discontinuties
  • run across blood vessels

these disruptions lead to the formation of lateral canals

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3
Q

most frequent area of lateral canals?

A

APICAL THIRD

- do not forget they are in the FURCATIONS OF MOLARS

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4
Q

describe dentinal tubules

A

number and size

  • decrease from pulp to cementum
  • decrease from cervical to apical
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5
Q

dentinal fluid - basic

A

content of the dentinal tubules

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6
Q

pressure within the dentinal fluid

A

approx. 14 cm H20 - 10.3 mmHg

some pressure directed outwards

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7
Q

features of dentinal fluid

A

protective and transport media

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8
Q

brannstrom’s hydrodynamic theory

A

the rapid movement of dentinal fluid in the dentinal tubules stimulates the A-delta nerve fibers located in the odontblastic layer of the pulp

  • mechano-stimualtion
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9
Q

significance with the apical foramen

A

most significant pathway of communication between pulp and periodontium

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10
Q

periodontal aspects of clinical exam imoortance

A

PD (probing depth)

bleeding on probing

purulence

mobility

density of marginal bone

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11
Q

SOAP format

A

S - subjective findings

O - Objective Findigns

A - Assessment (diagnostic pulpal-peri-radicular)

P - Pain of treatment

  • endo
  • perio
  • prosth
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12
Q

what compromises subjective findings

A
  1. chief complaint

2. history of present condition

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13
Q

what compromises objective findings

A
  1. clinical exam
  2. radiogrpahic exam
    diagnostic tests
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14
Q

heat test have to keep for longer?

A

yes - because C fibers are slower to respond

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15
Q

tracing the sinus tract importance?

A

NEED TO SEE WHERE IT ENDS – so maybe a vertical radiograph will be beneficial

is there maxillary sinus involvement?

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16
Q

accuracy of CBCT is in determining vertical root fractures?

A

HELPFUL

- 86% vs 66% (when using a PA)

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17
Q

which slices in CBCT are most accurate?

A

AXIAL slices

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18
Q

average sensitivity of CBCT for vertical root fracture

A

50%

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19
Q

dentin infection how?

A
  1. death of odontoblast
  2. dead tract
  3. bacterial infiltration
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20
Q

pulpal response to carious lesion

A
  1. pulpal inflammation
  2. local tissue destruction
  3. formation of microabscesses
    - attempt to wall off infection
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21
Q

frequently overlooked findings radiographically

A
  1. sinus tract
  2. resorptive defect
  3. perforation
  4. bone rarefraction pattern /
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22
Q 
clinical diagnosis (3) 
these are NOT WHAT
A
  1. cracked tooth
  2. VRF
  3. endo-perio lesion

*these are NOT describing pulpal or perio diagnose

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23
Q

is there an effect of periodontal inflammation on the pulp?

- general

A

yes and no
- research defending both sides

likely in extreme conditions

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24
Q

classification on endo-perio lesions

Simon 1972

A
  1. primary endodontic lesion with secondary periodontal involvement
  2. primary periodontic lesion with secondary endodontic involvment
  3. true combined endo-perio lesion
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25
Q

primary perio with 2nd endo

A

can reach apex and then effect the pulp

- irreversible pulpitis stage or necrotic

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26
Q

combined?

A

endodontic disease - bacteria wants to go out

and at same time
- perio lesion from crest of bone down and they meet

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27
Q

endodontic drainage?

A

path of least resistance?

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28
Q

endodontic drainage?

A

path of least resistance?

- so case dependent

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29
Q

spread of odontogenic infection

A

anatomic position of tooth in relation to buccal and lingual cortical plates \relationship of apex of tooth to closest muscle attachment

30
Q

main features of primary endo secondary perio

A
  1. pulp necrosis
  2. good oral hygeine
  3. no perio disease
  4. intrasulcular drainage
    - tunnel/ narrow probing
    - furcation involvment
  5. non angular crestal bone loss
31
Q

main features of primary perio secondary endo

A
  1. chronic disease
  2. angular bone loss – slow destruction of attachment apparatus
  3. pain is low intensity to hard to localize
  4. tooth may be vital
  5. corono-apical direction
  6. produces wide probing
  7. looser gingival margina
  8. pulp will survive unless foramen area is compromised
32
Q

common ways endo -peerio lesions

although they are uncommon they are associated with endo-perio lesions

A
  1. enamel pearl
    - usually in molar furcation areas
  2. cemental tear
    - piece of radio-opacity
  3. palatal groove
    - on upper anterior teeth
33
Q

importance of probing?

A

narrow or wide?

narrow – endo more likely

34
Q

VRF hard to diagnose?

A

yes - because they mimic endo-perio lesions

35
Q

severity of periodontal disease correlate with pulpal necrosis?

A

some studies show both (yes and no)

  • pulp can affect the periodontium
  • there is more epithelium around infected teeth
  • there is more connective tissue around non-infective teeth

so before perio procedure need to makesure you have a healthy pulp situation

36
Q

Tx. strategies and clinical outcome depends on?

A
  • extent of perio disease
  • assessment of therapeutic prognosis, with the intended regenerative procedure
  • tooth mobility
  • properly performed root canal treatment
  • appropriate healing time

NEED GOOD PERIO PROGNOSIS
- then do endo and then wait 2/3 months for healing

37
Q

steps to examine a tooth with a crack

A
  1. perio probing
  2. radiographic examination
  3. restoration removal
  4. staining
  5. transilluminaiton
  6. wedging forces
  7. surgical assessment
38
Q

classification of cracked teeth

A
  1. craze lines
  2. fracture cusp?
  3. cracked tooth
  4. split tooth
  5. vertical root fracture (VRF)

*goes in order of not as ‘big of a problem to more’

39
Q

craze lines usually present as? where?

A

on posterior teeth
- marginal ridges
extend B and or L

anterior teeth
- long vertical

clinical
- enamel (limited to here usually), no symptoms, esthetic concerns

depending on how light hits it?

40
Q

diagnose craze lines?

A

transillumination

- DD = fractured cusp

41
Q

transillumination differentitates?

A

Light is still PASSING THROUGH CRAZE LINE
- IF CROSSES OVER – MEANS CRACK IS NOT DEEP – SO NOT A CRACK – CRAZE LINE

IN CRACK
LIGHT STOPS AT FX LINE - does not cross over line

42
Q

fractured cusp

A

complete or incomplete

  • cna look like a craze line
  • surrounds a cusp M-D and B-L
  • above or below CEJ
  • LIGHT STOPS AT FX LINE
43
Q

craze lines limited to?

A

enamel

- if crosses into dentin - it is a crack

44
Q

bite test

A

cusp specific
- pressure on specific cusp on the tooth to break down bite test into the different points on the same tooth

flexure??
- will be pain and pulp reation

NOT USEFUL ON PREVIOUSLY TREATED
- no pulpal response

45
Q

fractured cusp treatemtn

A
  • assess pulp vitality
  • remove effected pulp
  • assess restorability
  • restore cusp or full cuspal protection

+/- RCT (seldom needed if just a fracture in the cusp)
- if pulp involvement obviuoustl treat this - if not move onto the restorative component

46
Q

fractuer cusp different from cracked tooth?

A

YES

47
Q

cracked tooth starts where?

A

STARTS AT CROWN LEVEL

- called greenstick fracture / incomplete fracture

48
Q

cracked tooth usually extends?

A

M-D : marginal ridges (centered)

- if apically (+/- pulpal involvement)

49
Q

diagnostic clues for cracked tooth

A

PAIN ON RELEASE

  • place instrument in crack
  • use wedging test
50
Q

no movement?

A

cracked tooth

51
Q

piece breaks off with wedge test

A

fractured cusp

52
Q

crown and root movement with wedge test

A

split tooth

53
Q

cracked tooth tx. planning? guided by?

A

guided by endo diagnosis

  • pulp and periapical) and perio diagnosis
  • endo tx if needed

exaplin prognosis and different options

54
Q

tx considerations with cracked tooth

A

chasing the crack line in a vital tooth

55
Q

prognosis of cracked tooth

A

based on clinical findings and clinical judgement

share findings with pt. and discuss

if left unprotected – can naturally lead to a split tooth

clinical research studies are limited

56
Q

prognosis of split tooth

A

poor

- probably needs extraction

57
Q

split tooth

A

complete fracture

crown down to apical area

M-D direction

tooth segments are seprate
- wedge test

58
Q

VRF characteristics

A

initiated at the ROOT at any level

  • usually extend towards the occlusal surface/ chewing surface
  • usually are found when surrounding bone and gum become infected

B-L direction

complete or indirect

59
Q

VRF diagnostic clues

A
  • minimal
  • mimics endo- perio lesions
  • almost always associated with RCT
  • narrow deep or rectangular pattern probing
60
Q

VRF pathognomonic signs

A

sinus tract AND narrow isolated probing AND previous RCT

  • independent of presence of post
  • may be presence of amalgam in canal orrifice
61
Q

VRF tx

A

extraction

hemisection or root amputation when indicated

62
Q

VRF prevention

A

avoid excessive removal of tooth structure

avoid wedging forces especially if lateral condensation is used

avoid post placement unless needed for crown retention

63
Q

VRF prevention

A

avoid excessive removal of tooth structure

avoid wedging forces especially if lateral condensation is used

avoid post placement unless needed for crown retention

64
Q

crack goes M-D what type?

A

crack tooth

not syndrome

65
Q

prognosis if crack is identified early enough?

A

dont jump to endo

- crown can be protective to a certain extent

66
Q

Ng. et all 2011 importance? conditions found to improve tooth survival?

A

conditions to improve tooth survival:

  • patency of canal is acheived
  • absnence of root filling extrusion
  • teeth with cast restoration after tx
  • teeth with adjacent teeth present
  • no cast and pore for support
67
Q

fracture necrosis associated with?

A

pulp necrosis in the absence of restorations, caries, or luxations injuries, is likely caused by a longitudinal fracture extending from occlusal surface into the pulp

extractions may be considered tx of choice

68
Q

cemental tear?

A

basically necrotic cementum with microorganisms

-piece of cementum that detaches from the root

69
Q

how involvement of a palato-ginginval groove can present

A
  • no cavitities or restoration
  • poor oral hygeine
  • negative pulp test
    positive percussion
    PD WNL except a drop of 10mm on PL + pus

mobility WNL

70
Q

TX of palato-gingival groove

A

prophy

NSRCT
- scaling and root planning

open flap depridement in apex area

treat surface

bone graft and collagen membrane

CHX use

follow up

71
Q

direction of crack for cracked tooth vs VRF

A

VRF- from B-L

cracked tooth - from M-D

Endotontics (21 decks)

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