EndoPerio Flashcards
Clinical Presentation for Endo/Perio
Lesions
(4)
- Clinical scenarios involving both pulp and
periodontium - Acute
- Chronic
- If related to recent traumatic or iatrogenic event,
may manifest as PAIN with an Abscess
Signs and Symptoms
(2)
- Deep periodontal pockets (approaching apex)
- Altered or negative response to pulp vitality
(sensibility) tests
Signs and Symptoms
(6)
- Bone resorption in apical or furcation region
- Spontaneous pain or pain on palpation/percussion
- Exudate
- Tooth mobility
- Sinus tract
- Crown and gingival color changes
Etiology
- Microbial contamination of the pulp and
periodontium
A. Related to periodontal &/or endodontic infection
B. Related to trauma/Iatrogenic factors
Perio/Endo infection
(3)
- Primary Endodontic
- Primary Periodontic
- True ‘Combined’ lesion
- Primary Endodontic
- caries affecting pulp and subsequent periodontal
involvement
- Primary Periodontic
- periodontal destruction that then affects the pulp
Associated with Trauma/Iatrogenic
Factors
(3)
- Root damage
- External root resorption (due to trauma)
- Necrotic pulp (from trauma then draining through
periodontium)
- Root damage
(2)
- Perforation of root, pulp chamber or furcation (during
preparation for root canal or post) - Root fracture or crack (iatrogenic or trauma)
Bacterial Profile
(2)
- Generally, there is not a specific microbial profile
for the EPL - No major difference between lesion of endodontic
origin vs. periodontal origin
Risk Factors (affect prognosis)
(3)
- Advanced periodontal disease
- Trauma and iatrogenic events
- Anatomic factors
- Anatomic factors
(3)
- Root grooves**
- Furcation involvement
- PFM crowns and active carious lesions
So why the change?
Original diagnostic classification for EPL was
(5)
- Primary endo
- Primary endo secondary perio
- Primary perio
- Primary perio secondary endo
- True combined lesion
However, determining primary source is not relevant for treatment as
both root canal and periodontal tissues require treatment
Diagnosis
Base treatment options on presenting disease status
* Determine prognosis
(3)
- Hopeless (usually due to trauma/iatrogenic
factors and leads to extraction) - Poor
- Favorable
Diagnosis
(3)
- Determine history (if known) of root damage
- Obtain radiographs and clinical examination
- Determine root anatomy and integrity
- Determine history (if known) of root damage
- trauma, root canal treatment, post preparation
- Obtain radiographs and clinical examination
- probing depths, perforation, fracture, root resorption
No evidence of root damage
Perform full periodontal assessment
(6)
- Probing depths
- Attachment levels
- Bleeding/suppuration
- Mobility
- Percussion
- Vitality testing
Assessment
(for 2017 classification)
Need to determine if tooth in question has
(2)
a) Root damage (and if so, what type?)
b) No root damage
b) No root damage
(2)
a) Periodontitis patient ?
b) Non periodontitis patient ?
Endo-Periodontal lesion with root damage
(3)
Root fracture or crack
Root canal or pulp chamber perforation
External root resorption
Perio-Endo
* Difficulty in
* Difficulty in
* Difficulty in
Diagnosis
Treatment
Determining Prognosis
Physical Routes of
Communication
(4)
- Apical Foramen
- Lateral (Accessory) Canals
- Dentinal Tubules (Controversial)
- Iatrogenic
- Lateral (Accessory) Canals
- Kirkham (75) found –% and Rubach
(65) found –% on single-rooted teeth - Gutman (78) found –% in molar
furcations**
28
45
28
Physical Routes of
Communication
Dentinal Tubules
Seltzer (67) found –% incidence of
inflammation in pulp and
periodontium
Adriaens (88) demonstrated —
in dentinal tubules (false positives in
controls may indicate contamination)
21
bacteria
Healing Potential
Osseous lesions of endodontic origin
can be expected to —
Osseous lesions of periodontic origin
are usually —
The greater the periodontic
involvement, the — the prognosis
heal completely
not reversible and depend on defect morphology for regeneration
worse
Differential Diagnosis
(4)
Incomplete Tooth Fracture
Developmental Grooves
Cervical Enamel Projections
Periodontal Abscess
Incomplete Tooth Fracture
(4)
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
Developmental Grooves
(3)
Gingival palatal groove incidence of
4-8% on maxillary incisors
Localized osseous lesion
“Peri-pulpal” line on radiograph
Cervical Enamel Projections
(2)
Various extent of CEPs from grade I
to grade III (which extend into
furcation)
Incidence from 17-32% (much
higher incidence in Asian
populations)
Periodontal Abscess
(3)
Symptoms consistent with
periodontal abscess
Radiograph is indicative of
periodontal disease
Acute abscess has better prognosis
than chronic abscess
Treatment Considerations
— evaluation is needed with
endodontic evaluation to determine
prognosis and treatment options
— usually is done first
— follows endo
(2) may be
viable alternative
Periodontal
Endodontics
Periodontal therapy
Root resection or hemisection
