endo-perio lesions

Question 1

what is the proposed aetiology for endo perio lesions?

Answer 1

communication between the pulpal and periodontal tissues

• endodontic or periodontal infections
• trauma
• iatrogenic factors

Question 2

describe the clinical presentation of an endo perio lesion

Answer 2

• an abscess accompanied by pain
• in periodontitis it can have slow and chonic progression without evident symptoms
• large range in presentation

Question 3

what are signs and symptoms of a endo perio lesion?

Answer 3

• 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

Question 4

how do endodontic infections result in an endo perio lesion?

Answer 4

• 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

Question 5

how do periodontal infections result in an endo perio lesion?

Answer 5

• periodontal destruction that secondarily affects the root canal
• evidence that despite periodontal disease advancement, pulp vitality is maintained

Question 6

what is a combined lesion?

Answer 6

• periodontal and endodontic infections occuring concomitantly
• can occur in periodontitis or not periodontitis patient

Question 7

how do you differentiate between an periodontal or endodontic lesion

Answer 7

Question 8

what are the risk factors for endo perio lesions

Answer 8

• severe periodontitis
  
  • widening of periodontal pockets
• active carious lesions
• grooves
• furcation involvement
• trauma
• iatrogenic events
• porcelain-fused to metal crowns - possibly

Question 9

describe the simon (1972) modified by gargiulo (1984) method of classification for endo/perio lesions

Answer 9

Question 10

what is the currently used for classification of endo/perio lesions

Answer 10

2017 world workshop classification

Question 11

what is a grade 1 endo perio lesion?

Answer 11

lesion with a narrow and deep periodontal pocket affecting 1 tooth surface

Question 12

what is a grade 2 endo perio lesion?

Answer 12

lesion with a wide deep periodontal pocket in 1 tooth surface

Question 13

what is a grade 3 endo perio lesion?

Answer 13

a lesion with a deep periodontal pocket in more than 1 surface

Question 14

what steps should have been carried out before the presence of an endo perio lesion can be determined?

Answer 14

1. history (trauma/RCT/post)
2. evaluate for root integrity
   
   • clinically and radiographs
   • perforations, fractures, cracking, external root resorption
3. assess tooth vitality
   
   • if postieive - more difficult
   • multirooted tooth may have canals with various states of pulpal degeneration
4. full mouth periodontal assessment

Question 15

what does the prognosis of an endo perio lesion depend on?

Answer 15

• 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

Question 16

what is the treatment guidance for an endo lesion? what considerations should be made during diagnosis?

Answer 16

endodontic treatment only

inflammation may exit via PDL mimicking periodontitis

Question 17

what is the treatment guidance for an perio lesion? what considerations should be made during diagnosis?

Answer 17

periodontal therapy only

be aware of reliability of vitality testing with advanced perio lesions

Question 18

what is the treatment guidance for an endo lesion with secondary perio involvement? what considerations should be made during diagnosis?

Answer 18

endo therapy first then follow up in 1-3 with periodontal therapy

diagnosis easier when pulp vitality is negative

Question 19

what is the treatment guidance for an perio lesion with secondary endo involvement? what considerations should be made during diagnosis?

Answer 19

endo therapy first then follow up in 1-3 months with perio therapy

more difficult diagnosis

must be sure of endo involvement

Question 20

what is the treatment guidance for a true combined lesion? what considerations should be made during diagnosis?

Answer 20

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

Question 21

what steps must be performed in order to diagnose a endo perio lesion?

Answer 21

1. identify potential endo perio lesion ( deep pocket / radiographic defects)
2. determine root damage
3. determine periodontitis diagnosis / narrow or deep multiple pockets
4. investigate vitality of tooth
5. if endodontic involved - do RCT and review
6. if tooth viral - preserve vitality and do periodontal treatment
7. review

Question 22

how will a lesion present clinically and radiographically if there are concurrent endodontic and periodontal diseases without communication?

Answer 22

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

Question 23

what are the effects of periodontal treatment on pulp health?

Answer 23

periodontal treatment may also cause pulp inflammation, although usually only in the form of a reversible pulpitis reaction (rare)