Lecture 6: Endodontic-Periodontal Relationship Flashcards
It is the “challenge of the clinician” to _____________ & treat within their scope of practice and to _____ within their ability or referral range
discover all the problems; offer solutions
Describe some aspects to a lesion being of endodontic origin: (5)
- pain
- swelling
- percussion sensitive
- radiolucency
- increased probing
Describe sone aspects to a lesion being of periodontal origin: (5)
- pain
- swelling
- percussion sensitive
- radiolucency
- increased probing
What factors are common between a lesion being of endodontic origin as well as periodontal origin?
- pain
- swelling
- percussion sensitive
- radiolucency
- increased probing
Remember, periodontal health, function & stability is one of the basic requirements for any tooth being considered for:
endodontic treatment (as well as restorability & esthetics)
Regularly, any combination of multiple challenges of a tooth (endo & perio) will: (3)
- increase the difficulty
- reduce the prognosis
- limit the outcome of treatment
Involvement of endo and perio in the same tooth results in:
lesser prognosis than either disease alone
T/F: Endo is involvement is almost always the limiting factor
False- perio involvement is almost always the limiting factor
What do you need prior to beginning any treatment if you suspect endo & perio involvement: (4)
- endo pulpal diagnosis
- periapical diagnosis
- periodontal diagnosis
- periodontal prognosis (idea)
Irritants from diseases pulp may pass through ____ into periodontal tissues
lateral canals
lateral canals are also called:
accessory canals
T/F: Most often lateral (accessory) canals are NOT visible radiographically but are discovered following obturation
True
How often do we see lateral (accessory) canals in molars?
23-76%
What is a natural protective barrier of the tooth/root?
cementum
____% of people have a VOID in the cementum at the CEJ
18-25%
Any void of cementum (or enamel) via agenesis, injury or aggressive SRP will:
expose dentinal tubules & pulp to attach from micro-organisms
List some causes of cemental agenesis or loss:
- tooth brush abrasion
- erosion
- bulimia & other destructive habits
- bruxism
- trauma
Cementum is thinnest or missing at:
CEJ
Iatrogenic pathways of communication are problems that:
we create as endodontic perforations or post perforations
Endodontic perforations or post perforations that we create during treatment is considered:
iatrogenic
With any problem we create as endodontic perforations or post perforations, the prognosis:
suffers
Where do we see multiple easy pathways of communication?
Between pulp and periodontium
T/F: You are rarely dealing with the pulp or peridontium alone
False- you are NEVER dealing with the pulp or periodontium alone
You are NEVER dealing with the PULP or PERIODONTIUM alone. Both must be a consideration in:
all treatments
Any 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, both:
the pulp and periodontium are involved
If the anomaly or injury is _____, both the pulp and periodontium are involved
apical to the gingival attachment
What type of fracture is often invisible on radiographs?
Vertical root fracture (VRF)
What type of fracture is commonly visible on radiographs?
Horizontal root fracture (HRF)
If you notice a J-shaped lesion and a drop-off pocket on the radiograph, you most likely are dealing with:
VRF
Dens en Dente=
Developmental groove
What is the success and survival of endodontically treated cracked teeth with radicular extensions?
90.6% success rate after 2-4 years
What are the five classifications of Endo-Perio lesions?
- Pure endo (Primary endo lesion)
- Pure perio (Primary perio lesion)
- Endo-Perio (Primary endo with secondary perio involvement)
- Perio-Endo (Primary perio with secondary endo involvement)
- “True” combined lesion (Combined vs. Conomitant perio & endo involvement)
A PURE ENDO lesion:
Primary endo lesion
A PURE PERIO lesionL
Primary perio lesion
Endo-perio lesion:
Primary endo with secondary perio involvement
Perio-endo lesion:
Primary perio with secondary endo involvement
Why is it that prognosis decreases significantly with any perio involvement?
Because we know that properly selected endo will have a 90+% success rate (regardless of the cooperation of the patient
However, perio success largely depends on the ability to motivate the patient to take care of their shortcomings which were responsible for the perio disease in the first place
T/F: Perio involvement decreases the prognosis (as opposed to endo involvement)
True
Properly selected endo cases will have a ____% success rate (largely regardless of the cooperation of the patient)
90+%
Perio success rate depends largely on the ability to:
motivate the patient
Classifications of the endo-periodontal lesion include: (2)
- eddo-periodontal lesion WITH root damage
- endo-peridontal lesion WITHOUT root damage
The classification “endo-peridontal lesion WITHOUT root damage” can be further divided into:
A) Endo-periodontal lesion in PERIODONTITIS patients
B) Endo-periodontal lesion in NON-PERIOTONTITIS patients
A pure endo case, results form a:
primary endo lesion
Which of the five categories has the best prognosis?
- Pure endo (Primary endo lesion)
- Pure perio (Primary perio lesion)
- Endo-Perio (Primary endo with secondary perio involvement)
- Perio-Endo (Primary perio with secondary endo involvement)
- “True” combined lesion (Combined vs. Conomitant perio & endo involvement)
Pure endo (primary lesion)
With a pure endo lesion, what treatment is indicated?
RCT Only
With a pure endo diagnosis, a ____ initiates forthcoming LEO.
Extension of the pulpal inflammation precedes to the canals, out the apex and irritates the periodontal (P/A tissues) creating _______
pulpal injury; periodontal disease and loss of bone.
With a pure endo lesion, a _____ originating from the apex or lateral canal may form along the root surface and exit Bia the gingival sulcus
drainage tract
With a pure endo lesion, a drainage tract originating from the apex or lateral canal may form along the root surface and exit Bia the gingival sulcus. This is NOT a ____. Also is NOT a classic ____ but is serves the same purpose of draining the lesion (via the sulcus)
True perio pocket; DST
T/F: A true perio pocket can be seen with a primary endo lesion
False
The clinical pulpal diagnosis for a PURE ENDO lesion indicates:
Necrotic pulp
A PURE ENDO lesion often has a _____ onset with evidence of _____
rapid; pulpal damage (caries, trauma, etc.)
With a PURE ENDO lesion in molar teeth, the furcation area nay appear to have:
- significant bone loss
- minimal to no calculus
- no evidence of generalized or advanced periodontitis
T/F: With a PURE ENDO lesion, the tooth may be mobile or exhibit a narrow channel sinus tract via a sulcus
True
Diagnose- Your patient presents to the clinic with:
- swelling present in the attached gingiva
- soreness of tooth with biting down
- they state this had a very rapid onset
Upon examination you note:
- tooth mobility
- pulpal diagnosis of necrotic pulp
- caries present on the tooth in question
- minimal calculus & healthy gum tissue
- bone loss in the furcation area of tooth
Pure endo (primary endo lesion)
The prognosis of a PURE PERIO lesion:
totally dependent upon perio treatment success and motivation of patient
With a PURE PERIO lesion, the treatment is limited to:
periodontal therapy only
With a PURE PERIO lesion, the treatment is limited to periodontal therapy ONLY, with the prognosis dependent upon the ability to remove ____ and the patients ability to achieve _____ practices
causative factors; meticulous self-care
With a PURE PERIO lesion, clinical & radiographic assessments indicate:
-generalized, moderate to deep bony pockets (cone-shaped & wide)
-calculus present
-diffuse inflammation
-asymptomatic patient
-pulp response to sensibility testing WNL
Can calculus typically be seen on an exam with a patient with a PURE PERIO lesion?
yes
What symptoms will the patient present with if they have a PURE PERIO lesion? What are the results of pulp testing?
Asymptomatic patient; pulp responds to sensibility testing WNL
Diagnose- Your patient presents to the clinic with:
-generalized moderate deep bony pockets (cone-shaped & wide)
-heavy calculus
-diffusely inflamed gingiva
Upon examination you note:
-the patient is not in pain
-the tooth in question responds WNL to pulp sensibility testing (Vital pulp)
-no deep caries or trauma to the tooth in question
-generalized periodontal disease and vertical bone loss
Pure perio (primary perio lesion)
T/F: With PURE PERIO lesion, there may be caries and injury to the pulp
false- no caries nor injury to the pulp
What is the primary cause of an ENDO-PERIO lesion? What is the secondary cause?
Primary: endo
Secondary: perio involvement
What is the prognosis for Endo-Perio lesions?
guarded to poor prognosis
What aspect makes the prognosis for an ENDO-PERIO lesion guarded to poor?
Perio involvement
What treatment is indicated for an ENDO-PERIO lesion?
Both RCT and periodontal treatment
Both an RCT and Periodontal treatment are indicated for Endo-Perio lesions. Simultaneous end and perio management is preferable. ____ first and then _____.
RCT; Perio
T/F: With an ENDO-PERIO lesion, simultaneous endo and perio management is preferable
True
With an ENDO-PERIO lesion, what should come first- RCT or perio therapy?
RCT
The prognosis for resolution of ENDO-PERIO lesion is dependent upon ability to:
Treat BOTH entities successfully
What is the difference in pockets for a PURE PERIO lesion vs. ENDO-PERIO lesion?
PURE PERIO: Moderate deep bony pockets (cone-shaped & wide, calculus present)
ENDO-PERIO: Unusual deep pockets; little or no calculus present
The clinical pulpal diagnosis for an ENDO-PERIO lesion indicates:
necrotic pulp
Diagnose- Your patient presents to the clinic with:
-evidence of periodontal disease around the tooth in question
-vertical bone loss
-inflamed gingiva around the tooth in question
-little to no calculus
-no generalized periodontitis
Endo-perio lesion
Your patient presents to the clinic and you note radiographic changes in the pulpal space visible with linear or isolated calcific changes. What’s a potential diagnosis?
Endo-perio lesion
