Endo-Perio Lesions Flashcards
What does an endo-periodontal lesion describe?
A pathologic communication between pulp and periodontal tissues
What is the prevalence of accessory canals?
27-69%
What can the clinical presentation of an endo-perio lesion be in periodontitis?
Slow and chronic progression without evident symptoms
What are the signs and symptoms fo endo-perio lesions?
Deep periodontal pockets (~10mm), altered response to pulp vitality tests, bone resorption in apical/furcation region, spontaneous pain/pain on palpation and percussion, purulent exudate, tooth mobility, sinus tract, and crown and gingival colour alterations
What is the aetiology of endo-perio lesions?
Endodontic/periodontal infections, trauma, and iatrogenic factors
What is an endodontic infection?
An endodontic lesion that affects pulp and, secondarily, affects periodontium
How can an endodontic lesion mimic a periodontal abscess?
Lesion may drain coronally through PDL into gingival sulcus
How can a periodontal infection lead to an endo-perio lesion?
By periodontal destruction that secondarily affects root canal
What are true periodontal pockets wider than?
An endodontic sinus alone
What are combined lesions?
Periodontal and endodontic infections occur concomitantly “true combined”/combined
Who can combined lesions occur in?
Periodontitis/non-periodontitis patient
What are the signs and symptoms of a periodontal infection?
Periodontal disease demonstrates a wider PDL coronally, radiographic evidence of crestal bone loss, multiple wide encompassing pockets, often unrestored teeth, pain tends to be moderate and dull, swelling of attached gingivae, and pulp testing normal
What are the signs and symptoms of an endodontic infection?
Apical disease demonstrates a wider PDL apically, no crestal bone involvement, single and narrow pockets, heavily restored teeth, pain tends to be severe, swelling of apical zone, and pulp test altered/-ve
What are the signs and symptoms of trauma and iatrogenic factors?
Root/pulp chamber/furcation perforation, root fracture/cracking, external root resorption, and pulp necrosis (traumatic) draining through periodontium
What is the prognosis of endo-perio lesions of trauma and iatrogenic origin?
Poorer
What microorganisms are in endo-perio lesions?
Mostly periodontal pathogens from “red” and “orange” complexes: P. gingivalis, T. forsythia, Parvimonas micra, Fusobacterium, Prevotella and Treponema
What are the risk factors of endo-perio lesions?
Severe periodontitis, active carious lesions, grooves, furcation involvement, trauma, iatrogenic events, and porcelain-fused-to-metal crowns?
What are endo-perio lesions with root damage?
Root fracture, root canal/chamber perforation, and external resorption
What are endo-perio lesions without root damage?
Periodontitis/not periodontitis and grade 1, 2, or 3
What is a grade 1 endo-perio lesion?
Narrow deep periodontal pocket in 1 tooth surface
What is a grade 2 peri-endo lesion?
Wide deep periodontal pocket in one tooth surface
What is a grade 3 perio-endo lesion?
Deep periodontal pocket in more than one surface
How is an endo-perio lesion diagnosed?
History (trauma/RCT/post), evaluate for root integrity (clinical and radiographic), assess tooth vitality, and full mouth periodontal assessment (narrow/wide pockets-single/multiple surface)
How do we evaluate for root integrity?
Perforations, fractures, cracking, and external root resorption
What if there is a +ve vitality response?
Face a more difficult decision
What will 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 compliance with maintenance, and longevity of any restorations
What is the success rate of “Perio” endo-periodontal lesions without a concomitant regenerative procedure?
27-37%
What is the success rate of “Perio” endo-periodontal lesions with conventional orthograde root canal therapy?
93%
What could a radiographic lesion be mistaken as being a sign of if tooth is not tested with pulp sensibility tests?
Chronic apical periodontitis
What can periodontal pocketing mimick?
Periapical radiolucency
What are teeth with endo-perio lesions excluded from?
Main periodontal diagnosis
What is the treatment sequence for an endodontic lesion?
Endodontic treatment only
What is the treatment sequence for a periodontic lesion?
Periodontal therapy only
What is the treatment sequence for an endodontic lesion with secondary periodontic involvement?
Endodontic therapy first, follow-up in 1-3 months then periodontal therapy
What is the treatment sequence for a periodontal lesion with secondary endodontic involvement?
Endodontic therapy first, follow-up in 1-3 months then periodontal therapy
What is the treatment sequence for a true combined lesion?
Both therapies required, often endodontic canal medication followed by periodontal therapy, then reassessment prior to endodontic obturation
What is the guidance for an endo-perio lesion?
Identify potential endo/perio lesion (deep pocket/radiographic defects), determine root damage, determine periodontitis diagnosis/narrow/deep multiple pockets, investigate vitality of tooth, and review
What should you do if the tooth is vital?
Preserve vitality and do periodontal treatment
What should you do if endo-perio lesion is endodontic involved?
Do RCT and review
What are concurrent endodontic and periodontal diseases without communication?
A tooth that has apical periodontitis PLUS periodontal pocketing but they do not communicate with each other
What is seen clinically when probing periodontal pocket of concurrent endodontic and periodontal diseases without communication?
It does not extend as far as periapical lesion
What is seen radiographically in concurrent endodontic and periodontal diseases without communication?
Periodontal pocket does not extend as far as apical foramen of root canal, and bone can be seen between, and separating, periapical radiolucency and base of periodontal pocket
