Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endodontics 2 > Further Complications > Flashcards

Further Complications Flashcards

1
Q

Complicating Factors:
(3)

A

ENDO & PERIO
Fractures & Cracks
Resorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

REGULARLY: ANY combination of multiple challenges to a tooth will
(3)

A
  • Increase the Difficulty *
    *Reduce the Prognosis *
  • Limit the Outcome of TX *
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

INVOLVEMENT of Endo and Perio in the same tooth :
(2)

A
  • LESSER PROGNOSIS than either disease ALONE
  • PERIO involvement is almost always the LIMITING FACTOR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Now you need Endo Pulpal & Periapical Dx but ALSO

A

a Periodontal Dx
and some idea of the Periodontal Prognosis BEFORE you begin any Tx.
Helpful to know what came 1st (Endo or Perio)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Remember: Periodontal health, function
& stability is one of the Basic
Requirements for any tooth being
considered for Endodontic Tx.
Also (2)

A

RESTORABILITY & ESTHETICS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Dental Pulp intimately associated with
Periodontium and vice-versa:
(2)

A
  • Pulpal path. can infect periodontium
  • Periodontal path. can infect pulp
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

nterchange occurs via multiple pathways or
following therapeutic procedures:

A

Apical foramen #1 (Natural or Procedural)
Accessory or lateral canals
Dentinal Tubules/Caries
Areas of cemental agenesis
Resorptive defects
Tooth Cracks or Fractures
Following SRP & other periodontal &
surgical procedures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Lateral canals are
significant because they

A

allow pulpal disease to
extend directly to
periodontal tissues.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pathways of Communication:
#1: — : most
direct/common pathway*

A

Apical Foramen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Irritants from involved pulp may pass
through apical foramina into
periradicular tissues via

A

inflammation or infection extension
or during endodontic procedures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Irritants from periodontal
inflammation/injury /procedures may
pass through

A

apical foramina or
accessory (lateral) canals and directly
invade the dental pulp.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pathways of Communication
Lateral (accessory) Canals
Irritants from plaque that reach periodontal
tissues around lateral/accessory canals may
initiate
Lateral canals may be — + wide; bugs are @ —

A

inflammation in pulp followed by necrosis.

50um
.5-1um

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Lateral (accessory Canals)
– Irritants from diseased
pulp may pass through
lateral canals into
periodontal tissues
– This Lateral canal IS visible on XR
– Most often lateral (accessory) canals
are NOT visible radiographically but
are discovered following obturation.

(somewhat common) —% incidence In molars

A

23-76

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Other Pathways of Communication
* Areas of cemental agenesis or loss:
– Cementum is a natural
– —% may have a VOID @ CEJ)
– Any void of cementum (or enamel) via agenesis, injury or aggressive SRP will

A

protective barrier
18-25

expose dentinal tubules & pulp to attack from micro-organisms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q
  • Areas of cemental agenesis or loss:
    – Cementum is a natural protective barrier
    – 18-25% may have a VOID @ CEJ)
    – Any void of cementum (or enamel) via agenesis,injury
    or aggressive SRP will expose dentinal tubules
    & pulp to attack from micro-organisms.

(6)

A

-Tooth brush Abrasion
- Erosion
- Bulemia & other destructive habits
- Bruxism
- Trauma
Toothbrush Abrasion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Cementum is
thinnest or
missing at —

A

CEJ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

IATROGENIC Pathways of Communication

A

Problems we create as Endodontic Perforations or Post perforations

PROGNOSIS
SUFFERS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Note the MULTIPLE EASY PATHWAYS
between pulp and periodontium.

A

You are NEVER dealing with PULP or
PERIODONTIUM alone. Both must be a
CONSIDERATION in ALL TREATMENT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

ny anomaly or injury providing access to the
dentinal tubules also provides noxious access to
the pulp.
If the anomaly or injury is apical to the
gingival attachment,

A

both the Pulp and
Periodontium are involved.
Prognosis decreases ***

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Why is it that prognosis
decreases significantly with
any perio involvement ?

A

We know that most
properly selected endo will
have 90+ percentage
success (largely regardless
of the cooperation of the
patient)
Perio success, on the other
hand, depends largely upon
the ability to motivate the
patient to take care of their
shortcomings which were
responsible for the perio
disease in the 1st place.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

BEST PROGNOSIS
of the 5 Categories*
(no Perio)

A
  1. Pure Endo: Primary Endo Lesion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q
  1. Pure Endo: Primary Endo Lesion
    Pulpal injury initiates forthcoming

A Drainage Tract originating from the apex or a lateral
canal may form along the root surface and exit via the
gingival sulcus. This is

A

LEO. Extension
of the pulpal inflammation procedes to the canals,
out the apex and irritates the periodontium (P/A
tissues) creating periodontal disease and loss of
bone.

NOT a true perio pocket. Also is
NOT a classic Draining Sinus Tract (DST) but it serves the
same purpose of draining the lesion (via the Sulcus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q
  1. Pure Endo: Primary Endo Lesion
    CLUES:
    Clinical Pulpal DX indicates —
    Often a — Onset + evidence of —
    In molar teeth, the — area may appear to have significant bone loss.
    Minimal to no — & no evidence of generalized or advanced —
    Tooth mobile or exhibits a —
    Swelling present in the — and tooth sore to (2)
A

Necrotic Pulp
Rapid, pulpal damage (caries, trauma, etc.)
furcation
calculus, periodontitis
narrow channel sinus tract (perhaps via sulcus)
attached gingiva, biting or chewing.

24
Q
  1. Pure Endo: Primary Endo Lesion
    With this Dx:
A

RCT ONLY is
indicated.
Sinus tract & furca
should heal w/o Tx
following RCT
Do not curette
furcation region or
use caustic,
inflammatory
medications in the
pulp chamber.

25
Q
  1. Pure Perio: (Primary Perio lesion)
    Prognosis totally
    dependent upon
A

perio.
Tx success and
motivation of patient.

26
Q
  1. Pure Perio: (Primary Perio lesion)
    Clinical & radiographic assessments indicate
A

generalized, moderate to deep bony pockets
(cone shaped and wide) Calculus present
Diffuse inflammation
Asymptomatic patient & pulp responds to
sensibility testing WNL

27
Q
  1. Pure Perio: (Primary Perio lesion)
    CLUES:
    Clinical Pulpal Dx indicates —
    No deep — nor other significant pulpal injury
    Evidence for the presence of periodontal disease with (3) present.
A

Normal Pulp (VITAL)
caries
vertical bone loss, Inflamed soft tissue and calculus

28
Q
  1. Pure Perio: (Primary Perio lesion)
    When this Dx is
    determined:
A

TX is limited
to Periodontal Therapy
ONLY with the
prognosis dependent
upon the ability to
remove the causative
factors and the patient’s
ability to achieve
meticulous self-care
practices.

29
Q
  1. Endo-Perio: (Primary Endo with
    2ndary Perio Involvement)
    prognosis
A

Guarded to poor
prognosis due to perio.

30
Q
  1. Endo-Perio: (Primary Endo with
    2ndary Perio Involvement)
    (3)
A

Look for some unusual deep pockets
Little or no calculus in pockets
No generalized perio condition

31
Q
  1. Endo-Perio: (Primary Endo with
    2ndary Perio Involvement)
    CLUES:
    Clinical Pulpal Dx indicates
    Evidence for the presence of periodontal disease with (3)
    Radiographic changes in the pulpal space visible with —
A

Necrotic Pulp
vertical bone loss, Inflamed soft tissue and little or no calculus
linear or isolated calcific changes

32
Q
  1. Endo-Perio: (Primary Endo with
    2ndary Perio Involvement)
    When this Dx is
    determined:
A

Both RCT &
Periodontal Tx are
indicated.
Simultaneous
management of endo
and perio is preferable.
If pulp is necrotic, RCT
is 1st, then perio.
Prognosis for resolution
is dependent upon
ability to treat BOTH
entities successfully

33
Q
  1. Perio - Endo: (Primary Perio lesion with
    2ndary Endo Involvement)
    prognosis
A

Guarded to poor
prognosis due to perio.

34
Q
  1. Perio - Endo: (Primary Perio lesion with
    2ndary Endo Involvement)
    Clinical & radiographic assessments indicate
A

broad-
based probings, vertical & possible apical or lateral
bone loss.
Infection from the deep perio pocket invades the
pulpal tissue via the apical foramen & causes pulpitis
Symptoms acute & history of previous extensive
perio TX

35
Q
  1. Perio - Endo: (Primary Perio lesion with
    2ndary Endo Involvement)
    CLUES:
    Clinical Pulpal Dx indicates —
    Tooth often may have or needs —
    Evidence for the presence of
A

SIP or Necrotic Pulp
extensive restoration
periodontal disease with vertical bone loss,
Inflamed soft tissue and calculus present.

36
Q
  1. Perio - Endo: (Primary Perio lesion with
    2ndary Endo Involvement)
    TX
A

Successful TX is RCT
1st followed by and
dependent upon the
ability to remove the
causative factors for
both periodontal
disease and the
patient’s ability to
achieve meticulous self-
care practices once the
RCT has been
successfully performed.

37
Q
  1. “True” Combined Lesion: (RARE Combined or Concomitant Perio
    & Endo involvement)
    prognosis
A

Probably the poorest
prognosis of all types
(especially if associated
with a VRF = hopeless)

38
Q
  1. “True” Combined Lesion: (RARE Combined or Concomitant Perio
    & Endo involvement)
    Clinical & radiographic assessments indicate…
    Communication with…
    Symptoms may be…
    Probing may reveal…
A

broad based probings & intraboney perio pocket
an isolated peri-radicular lesion
of pulpal origin (same as 4. but both lesions develop
at the same time)
acute or chronic (if present – due
to pulpal inflammation)
vertical fracture (generally TE)

39
Q
  1. “True” Combined Lesion: (RARE Combined or Concomitant Perio
    & Endo involvement)
    CLUES:
    Clinical Pulpal Dx indicates —
    Tooth often has or needs — or has suffered —
    Evidence for the presence of…
A

Necrotic Pulp
extensive restoration, trauma
periodontal disease with vertical bone loss,
Inflamed soft tissue and calculus present.

40
Q
  1. “True” Combined Lesion: (RARE Combined or Concomitant Perio
    & Endo involvement)
    TX
A

Perform RCT first to
manage acute symptoms
(if any). Treat periodontal
concomitantly. Successful
TX is dependent upon the
ability to remove all
causative factors for
periodontal disease and
the patient’s ability to
achieve meticulous self-
care practices once the
RCT has been performed

41
Q

HINK ABOUT IT:
* As a result of common pulpal-periodontal
communications & interactions:
(2)

A

– Given sufficient TIME & adequate NEGLECT,
many endo infections can progress to develop a
perio component.
– Given sufficient TIME & adequate NEGLECT,
many perio infections can progress to develop an
endo component.

42
Q

— is one of
the best means
to differentiate
endodontic from
periodontal
pathosis.

A

Pulp sensibility
testing

43
Q

The more
time that
passes; the
more

A

difficult &
confusing
the Dx.

44
Q

Pulpal Inflammation
impact on Periodontium
Acute or chronic?
Symptoms?
XR
Pocket

A
  • Process Rapid & Acute
  • Pulpal symptoms often
    present
  • Radiographic appearance of
    extension to the
    periodontium usually an
    Isolated Finding
  • Pocket narrow, drop-off, no
    calculus
45
Q

Periodontal Inflammation
impact on the Pulp
Acute or chronic?
Pulp undergoes..
Symptoms?
Disease?
Pocket

A
  • Process Chronic
  • Pulp undergoes Slow
    Degeneration
  • Pulpal symptoms usually
    absent
  • Generalized periodontal
    disease usually present
  • Pockets Wide base,Cone-
    shaped, usually calculus
    present
46
Q

DIFFERENTIAL Dx: Fractures
(3)

A

VRF (Often invisible on XR)
* HRF (Commonly visible on XR)
* Developmental Groove (Dens en Dente)

47
Q

DIFFERENTIAL Dx: Resorption
2

A

internal
external

48
Q

INTERNAL RESORPTION is
routinely and successfully treated
with

A

RCT (if NOT perforating)

49
Q

Invasive EXTERNAL (of several types) resorption has been treated
by several methods;

A

None have
routinely predictable successful
outcome . . . over time.

50
Q

ENDO ONLY except perforating
Think of IRR as a change in the
nature of

A

PULPAL dendritic cells
into clastic cells resulting in
damage to the internal tooth
structure (W/O PROPER REPAIR)

51
Q

ENDO & PERIO
Think of ERR as a change in the
nature of

A

PDL cells which
causes largely osteoblastic
cells to activate –clastic cells
resulting in damage to the
external tooth structure (W/O
PROPER REPAIR)

52
Q

It’s IMPORTANT to determine if you are
dealing with Internal or External Resorption*
* IRR: (arises in the PULP cells)
– Usually…
– A — & well circumscribed lesion arising in the pulp which…
– — defect: well-rounded with smooth borders, integral with pulp
– Regardless of the angle exposed, radiographic lesion…
– Unable to — lesion on exterior of tooth (unless perforating)
– Lamina dura and PDL…

A

asymptomatic VITAL PULP (found on XR)
symmetrical, disrupts the normal architecture of the canal.
Internal
always remains centered on the root unless perforating to the facial or the lingual.
probe
intact around entire root surface(unless perforating)).

53
Q

ERR: (arises in the PDL cells)
Pulp is often —
A lesion which occurs on the — surface of the root
Often may be detected by…
An irregular shaped lesion arising in the — which…
Lesion “MOVES” as the — angulation of the X-ray is changed.
Lamina dure and PDL —.

A

Necrotic
external
an explorer on the exterior root surface
PDL, does not alter the normal architecture of the canal
horizontal
disrupted

54
Q

Other types of ERR (External Root Resorption):
(3)

A
  • Surface ERR (Self-limiting, Not discovered clinically) IGNORE
  • Chronic Apical Inflammatory ERR (Cratering of root apex – acknowledge,
    shorten prep and obturation) Expect good outcome.
  • Replacement ERR
55
Q
  • Replacement ERR
A

(Follows severe trauma (Avulsion/Intrusion), Resorption occurs,
Loss replaced by Bone) Creates Ankylosed & Submerged teeth.
Often unsuccessful; Consider as a “Temporary Measure” only.

56
Q

Treatment of Resorptive Defects::
(3)

A
  • All resorptive defects require CBCT for evaluation.
    REFER anything you are uncertain about Dx or Tx.
    REFER ALL RESORPTIONS at least for an Opinion
57
Q

TAKE AWAY* RCT is difficult enough by itself:
42
ADD ANY OTHER ISSUE with the
tooth or the patient . . .
(AAE RCT difficulty form)
— INCREASES
— DECREASES

A

DIFFICULTY
PROGNOSIS

Endodontics 2 (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions