endo perio lesion Flashcards
How do you get infection from the PDL to the pulp?
1. Pathogenic bacteria and inflam products of perio disease
2. Accessory canal/lateral canal/apical foramen
3. Pulpal infection/necrosis (RETROGRADE PULPITIS)
How do you get infection from pulp to PDL?
1. Pulpal disease (procedural errors in RCT, perforations, vertical root fractures)
2. Dentinal tubules, peri radicular inflam
3. Bone loss and clinical attachment loss +/- pus (RETROGRADE PERIODONTITIS)
How can you classify perio-endo lesions (Simon)?
1. Primary endodontic + secondary periodontal lesion (drains via PDL)
2. Primary periodontal + secondary endodontic lesion
= true combined perio-endo lesion (lesions coexist and fuse together)
What is another classification (Abbott and Salgano)?
Concurrent endo and perio disease w/o communication
Non communicating suggests a true combined lesion w independent aetiologies
Communicating- true combined that have merged OR primary perio/endo that have spread to the other
Why is knowing the original source of infection important?
May change management and prognosis of the case
How can you get a diagnosis?
History
Exam
Special test (ethyl chloride, EPT, PAs, OPT if multiple)
Clinical symptoms- swelling, pus, pocket, fistula tract, TTP, mobility
Endodontic- restorative status, TTP, sulcus tenderness, swelling/sinus
Periodontal- probe around tooth (sometimes pin point pocket), pus, bleeding, mobility
What is a J shaped lesion?
Combination of perio pocket and periapical pathology, looks like J
Don’t mistake for vertical root fracture
Why might you take a CBCT?
Conventional doesn’t have enough detail
Complex 3D anatomy
Suspicion of other causes- resorption/perforation
What are other tests that can be done to diagnose?
1.Tooth sleuth
2.Transillumination
Rules out root fracture/cracked tooth syndrome
How do you treat a perio-endo lesion?
1. Primary endo secondary perio= RCT ONLY (perio is just the sinus draining so will resolve, v narrow defect not conducive to instrumentation)
2. Primary perio secondary endo= RCT + PERIO THERAPY (perio aetiology but tooth also non-vital, do tx simultaneously as bacteria will recontaminate)
3. True combined lesion= RCT + PERIO THERAPY (may or may not communicate, do simultaneously)
How should you review a perio-endo lesion?
Review after 3 months, if still present- perio therapy
Review after another 3 months, consider prognosis and restorability, if still present- surgery
What are alternative managements?
1. Place CaOH inside prepped canal rather than obturating and do perio therapy at same time, only obturate when perio lesion is healing and pocket is reducing (no evidence that this is better)
2. Earlier surgical intervention if v deep pockets not conducive to therapy
3. One root affected more than another, can consider root resection/hemisection (resection-often mesio/distal buccal of uppers, hemisection- lowers)
What is the prognosis like for perio-endo lesions?
Primary endo secondary perio- generally good
Primary perio secondary endo and true combined- depends on extent of perio bone loss
What are lesions that masquerade as perio-endo lesions?
1. DEVELOPMENTAL GROOVES(if untreated, primary perio secondary endo, may require surgery)
2. PERFORATIONS (during tx, leads to pocket around area, bone loss half way up the root suggests this, may need extracting, or can use MTA or biodentine)
3. ROOT FRACTURES (J shaped lesion, v similar to primary endo secondary perio, assess extent, any vertical # extending into root face needs x)
4. RESORPTION (external cervical/external replacement/internal)
What is external cervical root resorption?
Unknown aetiology
Starts subgingival in cervical region
Pulp usually vital unless extensive
Often asymptomatic
Pocketing may be present
However gingival tissue fills it
CBCT can assess extent
Surgical exploration and repair
Then RCT
