Endo/Perio Lesions Flashcards
What are the clinical presentation for endo/perio lesions?
- Clinical scenarios involving both pulp and periodontium
- Acute
- Chronic
- If related to recent traumatic or iatrogenic event, may manifest as PAIN with an Abscess
What are the signs and symptoms of endo/perio lesions?
- Deep periodontal pockets (approaching apex)
- Altered or negative response to pulp vitality (sensibility) tests
- Bone resorption in apical or furcation region
- Spontaneous pain or pain on palpation/percussion
- Exudate
- Tooth mobility
- Sinus tract
- Crown and gingival color changes
What is the etiology of endo/perio lesions?
- Microbial contamination of the pulp and
periodontium
A. Related to periodontal &/or endodontic infection
B. Related to trauma/Iatrogenic factors
What is a primary endodontic infection?
caries affecting pulp and subsequent periodontal involvement
What is a primary periodontic infection?
periodontal destruction that then affects the pulp
What are the types of perio/endo infection?
- primary endodontic
- primary periodontic
- true “combined” lesion
What factors are associated with trauma/iatrogenic errors?
- Root damage
- External root resorption (due to trauma)
- Necrotic pulp (from trauma then draining through periodontium)
Is there a specific microbial profile for an endo/perio lesion?
Nope
What are the risk factors for endo/perio lesions?
- Advanced periodontal disease
- Trauma and iatrogenic events
- Anatomic factors
— Root grooves
— Furcation involvement
— PFM crowns and active carious lesions
What are the types of prognosis for perio/endo lesions?
- Hopeless (usually due to trauma/iatrogenic factors and leads to extraction)
- Poor
- Favorable
How do you diagnose an endo/perio lesion?
- Determine history (if known) of root damage
— trauma, root canal treatment, post preparation - Obtain radiographs and clinical examination
— probing depths, perforation, fracture, root resorption - Determine root anatomy and integrity
What is a full periodontal assessment (if no root damage)?
- Probing depths
- Attachment levels
- Bleeding/suppuration
- Mobility
- Percussion
- Vitality testing
Need to determine if tooth in question has…
a) Root damage (and if so, what type?)
b) No root damage
— Periodontitis patient ?
— Non periodontitis patient ?
What are the classifications for endo-periodontal lesions with root damage?
- Root fracture or crack
- Root canal or pulp chamber perforation
- External root resorption
What are the classifications for endo-periodontal lesions without root damage?
Why are perio/endo lesions difficult?
- Difficulty in Diagnosis
- Difficulty in Treatment
- Difficulty in Determining Prognosis
What are the physical routes of communication?
- Apical Foramen
- Lateral (Accessory) Canals
- Dentinal Tubules (Controversial)
- Iatrogenic
Osseous lesions of
endodontic origin can be expected to heal ___________
completely
Osseous lesions of periodontic origin are usually not reversible and depend on…
defect morphology for regeneration
The greater the
periodontic involvement, the _______ the prognosis
worse
What are the differential diagnosis for endo/perio lesions?
▪ Incomplete Tooth Fracture
▪ Developmental Grooves
▪ Cervical Enamel Projections
▪ Periodontal Abscess
What is an incomplete tooth fracture?
▪ Radiographic isolated vertical bone loss
▪ “Teardrop” radiolucency
▪ Can mimic both periodontal and endodontic symptoms
▪ May be seen as an incomplete crown, root, or tooth fracture
What are developmental grooves?
▪ Gingival palatal groove incidence of 4-8% on maxillary incisors
▪ Localized osseous lesion
▪ “Peri-pulpal” line on radiograph
What are cervical enamel projections?
▪ Various extent of CEPs from grade I to grade III (which extend into furcation)
▪ Incidence from 17-32% (much higher incidence in Asian populations)
What is a periodontal abscess?
▪ Symptoms consistent with periodontal abscess
▪ Radiograph is indicative of periodontal disease
▪ Acute abscess has better prognosis than chronic abscess
What are the treatment considerations for perio/endo lesions?
▪ Periodontal evaluation is needed with endodontic evaluation to determine prognosis and treatment options
▪ Endodontics usually is done first
▪ Periodontal therapy follows endo
▪ Root resection or hemisection may be viable alternative
