Endo perio diagnosis and treatment Flashcards
What are some ways the pulp/root canal can communicate with the periodontium?
Apical foramen
Accessory canals
Furcation/chamber canals
Exposed dentinal tubules – Due to developmental defects, disease, or periodontal treatment
Iatrogenic causes – Perforations, trauma (fractures), root resorption, caries, cracks
If we want to diagnose endo-perio, what will we be loking out for in the mouth?
Presence or absence of fractures & perforations
Presence or absence of periodontitis
Extent of periodontal destruction around the affected teeth
These factors are very important for determining the prognosis of the tooth
Are endo-perio lesons acute or chronic?
Both
What are the classifications of endo-perio lesions?
With or without root damage, but this is not always easy to determine.
Endo-perio lesions WITH root damage:
- Root fracture or cracking
- Root canal or pulp chamber perforation
- External root resorption
Endo-perio lesions WITHOUT root damage:
Endo-perio lesions in periodontitis patients
Endo-perio lesions in non-periodontitis patients
Explain the subgroups within the endo-perio patients WITHOUT root damage.
Endo-perio lesions in PERIODONTITIS PATIENTS:
Grade 1 – Narrow deep periodontal pocket in 1 tooth surface
Grade 2 – Wide deep periodontal pocket in 1 tooth surface
Grade 3 – Deep periodontal pockets in more than 1 tooth surface
Endo-perio lesions in NON-PERIODONTITIS PATIENTS (below is same as above)
Grade 1 – Narrow deep periodontal pocket in 1 tooth surface
Grade 2 – Wide deep periodontal pocket in 1 tooth surface
Grade 3 – Deep periodontal pockets in more than 1 tooth surface
What is the main endodontic aetiology for perio-endo lesions?
Factors include deep caries, trauma, extensive restorations, cracks, poor RCT, inadequate coronal seal, perforation, root fractures, resorption, and marginal breakdown of restorations.
Bacterial and pulpal by-products leak into peri-radicular tissues via communication pathways.
Inflammation leads to bone resorption in periodontal tissues, often resulting in drainage through the periodontium.
What is the main periodontal aetiology for perio-endo lesions?
Periodontal disease and periodontal treatment may cause pulpal inflammation
Rarely, when the periodontal pocket reaches the apex or though a furcation lesion, pulp necrosis may occur
What can we do to investigate endo-perio lesions?
History of dental trauma and previous dental treatment
Perio history
Loose teeth?
Pain history - pulpitis?
Caries or heavily-restored tooth
SPECIAL TESTS - sensibility testing, radiographic (look at crestal, furcation & apical bone) and gutta percha to determine the point of infection
What are some special tests we can do to find endo-perio lesions?
Sensibility tests - would cause a NEGATIVE RESULT!
Radiographic examination (assess crestal, furcation, and apical bone)
Gutta-percha point for identifying the infection’s origin -if around the apex, likely endo-perio lesion
What is a condition which may look like endo-perio but is not?
PERIODONTAL ABSCESS
Abscess:
sensitive tooth - positive response to vitality testing
No caries
Clinical attachment loss
Lateral radiolucency present
Mobile
Not really TTP
Sinus tract in keratinised gingiva
Endo-perio lesion:
non vital tooth
caries likely
Minimal clinical attachment loss
Apical radiolucency
Minimsl mobility
TTP
Sinus tract opensover alveolar mucosa
How do we treat an endo-perio lesion in a non-periodontitis patient?
Root treat the tooth and allow time for healing.
Avoid scaling root surfaces to preserve viable periodontal ligament cells for reattachment.
Review periodontal condition – should resolve completely if:
Periodontal component is not longstanding.
Root canal treatment (RCT) is successful.
How do we decide how to treat an endo-perio lesion in a periodontitis patient?
Assess periodontal prognosis – will it respond to treatment?
Evaluate RCT feasibility – can it be completed to a high standard?
Determine restorability – will the tooth be functional afterward?
Consider the strategic importance of the tooth.
Take patient preferences into account.
Weigh the option of extraction.
What are the options for endo-perio lesions in PERIODONTITIS patients?
OHI, supra- and sub-gingival debridement (with LA)
Complete RCT and allow time for healing
Treat residual periodontal disease (+/- surgery)
Prgonosis of endo-perio which have an endo aetiology?
Primarily Endodontic lesions have a better prognosis than perio aetiology patients as they are in a closed environment wound
Prgonosis of endo-perio which have an perio aetiology?
Primarily Periodontal lesions have a worse prognosis than perio aetiology patients as they are in a open environment wound
What are the 3 main prognoses for endo-perio lesions?
Three main prognostic groups for a tooth with EPL:
Hopeless
Poor
Favourable
Hopeless prognosis may be linked to trauma and iatrogenic factors.
EPL prognosis depends on the extent of periodontal involvement and the patient’s overall periodontal status.
What is external root resorption?
Pathological process on the outer surface of the tooth
Diagnosis: Radiographic + clinical exam, sensibility test may help
Symptoms: Asymptomatic, signs of irreversible pulpitis, discoloration, mobility
Intervention: Case-dependent, based on lesion extent
