endo-perio lesions Flashcards
what is the proposed aetiology for endo perio lesions?
communication between the pulpal and periodontal tissues
- endodontic or periodontal infections
- trauma
- iatrogenic factors
describe the clinical presentation of an endo perio lesion
- an abscess accompanied by pain
- in periodontitis it can have slow and chonic progression without evident symptoms
- large range in presentation
what are signs and symptoms of a endo perio lesion?
- deep periodontal pockets (~10mm)
- altered response to pulp vitality tests
- bone resorption in the apical or furcation region
- spontaneous pain
- pain on palpatation and percussion
- purulent exudate
- tooth mobility
- sinus tract
- crown and gingival colour alterations
how do endodontic infections result in an endo perio lesion?
- the endodontic lesion affects the pulp and then the periodontium
- it may drain coronally through the PDL into the gingival sulcus mimicking a periodontal abscess
how do periodontal infections result in an endo perio lesion?
- periodontal destruction that secondarily affects the root canal
- evidence that despite periodontal disease advancement, pulp vitality is maintained
what is a combined lesion?
- periodontal and endodontic infections occuring concomitantly
- can occur in periodontitis or not periodontitis patient
how do you differentiate between an periodontal or endodontic lesion
what are the risk factors for endo perio lesions
- severe periodontitis
- widening of periodontal pockets
- active carious lesions
- grooves
- furcation involvement
- trauma
- iatrogenic events
- porcelain-fused to metal crowns - possibly
describe the simon (1972) modified by gargiulo (1984) method of classification for endo/perio lesions
what is the currently used for classification of endo/perio lesions
2017 world workshop classification
what is a grade 1 endo perio lesion?
lesion with a narrow and deep periodontal pocket affecting 1 tooth surface
what is a grade 2 endo perio lesion?
lesion with a wide deep periodontal pocket in 1 tooth surface
what is a grade 3 endo perio lesion?
a lesion with a deep periodontal pocket in more than 1 surface
what steps should have been carried out before the presence of an endo perio lesion can be determined?
- history (trauma/RCT/post)
- evaluate for root integrity
- clinically and radiographs
- perforations, fractures, cracking, external root resorption
- assess tooth vitality
- if postieive - more difficult
- multirooted tooth may have canals with various states of pulpal degeneration
- full mouth periodontal assessment
what does the prognosis of an endo perio lesion depend on?
- presence of root damage
- amount of attachment loss prior to treatment
- patient’s healing responses
- effectiveness of endodontic treatment
- effectiveness of oral hygiene procedures
- patient complaince with maintenance
- longevity of any restorations
what is the treatment guidance for an endo lesion? what considerations should be made during diagnosis?
endodontic treatment only
inflammation may exit via PDL mimicking periodontitis
what is the treatment guidance for an perio lesion? what considerations should be made during diagnosis?
periodontal therapy only
be aware of reliability of vitality testing with advanced perio lesions
what is the treatment guidance for an endo lesion with secondary perio involvement? what considerations should be made during diagnosis?
endo therapy first then follow up in 1-3 with periodontal therapy
diagnosis easier when pulp vitality is negative
what is the treatment guidance for an perio lesion with secondary endo involvement? what considerations should be made during diagnosis?
endo therapy first then follow up in 1-3 months with perio therapy
more difficult diagnosis
must be sure of endo involvement
what is the treatment guidance for a true combined lesion? what considerations should be made during diagnosis?
both therapies required - often endodontic canal medication followed by perio, then reassessment prior to endodontic obturation
relatively rare but classic presentation is fractured or perforated root
what steps must be performed in order to diagnose a endo perio lesion?
- identify potential endo perio lesion ( deep pocket / radiographic defects)
- determine root damage
- determine periodontitis diagnosis / narrow or deep multiple pockets
- investigate vitality of tooth
- if endodontic involved - do RCT and review
- if tooth viral - preserve vitality and do periodontal treatment
- review
how will a lesion present clinically and radiographically if there are concurrent endodontic and periodontal diseases without communication?
clinically -
- when probing, it does not extend as far as the periapical lesion
radiographically -
- periodontal pocket does not extend as far as the apical foramen of the root canal
- bone can be seen between the periapical radiolucency and the base of the periodontal pocket
what are the effects of periodontal treatment on pulp health?
periodontal treatment may also cause pulp inflammation, although usually only in the form of a reversible pulpitis reaction (rare)
