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Endo 2 > Further Complications - (Endo-Perio) > Flashcards

Further Complications - (Endo-Perio) Flashcards

1
Q

REGULARLY: ANY combination of multiple challenges to a tooth will

  • _____ the Difficulty *
  • _______ the Prognosis *
  • ______ the Outcome of TX *
A

Increase
Reduce
Limit

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2
Q
  • _____ involvement is almost always the LIMITING FACTOR in endo treatment/ perio treatment
A

PERIO

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3
Q

Now you need Endo Pulpal & Periapical Dx but ALSO a Periodontal Dx
and some idea of the Periodontal Prognosis _____ you begin any Tx.

A

BEFORE

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4
Q

What is the #1 pathway where perio and endo Interchange that occurs?

A

Apical foramen #1 (Natural or Procedural)

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5
Q 
\_\_\_\_\_\_ are 
significant because they 
allow pulpal disease to 
extend directly to 
periodontal tissues.
A

Lateral canals

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6
Q

What is the most common pathway for endo to turn into perio and vice versa?

A

Apical foramen

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7
Q

Irritants from plaque that reach periodontal
tissues around lateral/accessory canals may
initiate inflammation in pulp followed by
______

A

necrosis.

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8
Q

Lateral canals may be ___um + wide; bugs are @

.5-1um

A

50

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9
Q

How often are lateral/furcation canals present in mand molars that can cause perio issues in necrotic pulps?

A

3/4 of time

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10
Q

– _______ is a natural protective barrier of the periodontium to pulp

A

Cementum

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11
Q

_____% may have a VOID @ CEJ)

A

18-25

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12
Q

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

A

True

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13
Q 
We know that most 
properly selected endo will 
have \_\_\_\_ percentage 
success (largely regardless 
of the cooperation of the 
patient)
A

90+

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14
Q

What is the success rate of perio treatment determined by?

A

Patient compliance with TX

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15
Q

Pulpal injury initiates forthcoming 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.
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 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)
13
CLUES: Clinical Pulpal DX indicates Necrotic Pulp
Often a Rapid Onset + evidence of pulpal damage (caries, trauma, etc.)
In molar teeth, the furcation area may appear to have significant bone loss.
Minimal to no calculus & no evidence of generalized or advanced periodontitis
Tooth mobile or exhibits a narrow channel sinus tract (perhaps via sulcus)
Swelling present in the attached gingiva and tooth sore to biting or chewing.
With this Dx:
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.

A

Pure Endo Lesion

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16
Q 
When this Dx is 
determined: 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          
CLUES: Clinical Pulpal Dx indicates Necrotic Pulp
Evidence for the presence of periodontal disease with vertical bone loss, 
Inflamed soft tissue and little or no calculus
Radiographic changes in the pulpal space visible with linear or isolated 
calcific changes
Look for some unusual deep pockets
Little or no calculus in pockets
No generalized perio condition
A

Primary Endo secondary perio

17
Q

Clinical & radiographic assessments indicate
generalized, moderate to deep bony pockets
(cone shaped and wide) Calculus present
Diffuse inflammation
Asymptomatic patient & pulp responds to
sensibility testing WNL
When this Dx is
determined: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.
CLUES: Clinical Pulpal Dx indicates Normal Pulp (VITAL)
No deep caries nor other significant pulpal injury
Evidence for the presence of periodontal disease with vertical bone loss,
Inflamed soft tissue and calculus present.

A

Perio Only

18
Q

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.
CLUES: Clinical Pulpal Dx indicates SIP or Necrotic Pulp
Tooth often may have or needs extensive restoration
Evidence for the presence of periodontal disease with vertical bone loss,
Inflamed soft tissue and calculus present.
Clinical & radiographic assessments indicate 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

A

Perio - Endo: (Primary Perio lesion with

2ndary Endo Involvement)

19
Q

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.
CLUES: Clinical Pulpal Dx indicates Necrotic Pulp
Tooth often has or needs extensive restoration or has suffered trauma
Evidence for the presence of periodontal disease with vertical bone loss,
Inflamed soft tissue and calculus present.
Clinical & radiographic assessments indicate broad
based probings & intraboney perio pocket
Communication with an isolated peri-radicular lesion
of pulpal origin (same as 4. but both lesions develop
at the same time)
Symptoms may be acute or chronic (if present – due
to pulpal inflammation)
Probing may reveal vertical fracture (generally TE)

A

“True” Combined Lesion: (RARE Combined or Concomitant Perio

& Endo involvement)

20
Q 
\_\_\_\_\_\_\_ is one of 
the best means 
to differentiate 
endodontic from 
periodontal 
pathosis.
A

Pulp sensibility

testing

21
Q 
\_\_\_\_ impact on \_\_\_\_\_\_
• Process Rapid & Acute
• Pulpal symptoms often 
present
• Radiographic appearance of 
extension to the 
periodontium usually an 
Isolated Finding
• Pocket narrow, drop-off, no 
calculus
• Process Chronic
• Pulp undergoes Slow 
Degeneration
• Pulpal symptoms usually 
absent
• Generalized periodontal 
disease usually present
• Pockets Wide base,Cone-
shaped,  usually calculus
A

Pulpal Inflammation

impact on Periodontium

22
Q 
\_\_\_\_\_\_ impact on \_\_\_\_\_\_ 
Process Chronic
• Pulp undergoes Slow 
Degeneration
• Pulpal symptoms usually 
absent
• Generalized periodontal 
disease usually present
• Pockets Wide base,Cone-
shaped,  usually calculus 
present
A

Periodontal Inflammation

impact on the Pulp

23
Q

INTERNAL RESORPTION is
routinely and successfully treated
with _____

A

RCT (if NOT perforating)

24
Q

Are there any Txs that give predictable outcomes for ERR?

A

No

25
Q

(arises in the PULP cells)
– Usually asymptomatic VITAL PULP (found on XR)
– A symmetrical & well circumscribed lesion arising in the pulp which
disrupts the normal architecture of the canal.
– Internal defect: well-rounded with smooth borders, integral with pulp
– Regardless of the angle exposed, radiographic lesion always remains centered on the root unless perforating to the facial or the lingual.
– Unable to probe lesion on exterior of tooth (unless perforating)
– Lamina dura and PDL intact around entire root surface(unless perforating)

A

IRR

26
Q

: (arises in the PDL cells)
Pulp is often Necrotic
A lesion which occurs on the external surface of the root
Often may be detected by an explorer on the exterior root surface
An irregular shaped lesion arising in the PDL which does not alter
the normal architecture of the canal
Lesion “MOVES” as the horizontal angulation of the X-ray is changed.
Lamina dure and PDL disrupted.

A

ERR

27
Q

_______ ERR (Self-limiting, Not discovered clinically) IGNORE

A

Surface ERR

28
Q 
\_\_\_\_\_\_\_ ERR (Cratering of root apex – acknowledge, 
shorten prep and obturation) Expect good outcome.
A

Chronic Apical Inflammatory ERR

29
Q

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

A

Replacement ERR

30
Q

All resorptive defects require _____ for evaluation.

A

CBCT

31
Q 
ADD ANY OTHER ISSUE with the 
tooth or the patient . . .
(AAE RCT difficulty form)
DIFFICULTY \_\_\_\_\_\_\_\_\_
PROGNOSIS \_\_\_\_\_
A

INCREASES;

DECREASES

Endo 2 (12 decks)

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