Lecture 6: Endodontic-Periodontal Relationship

Question 1

It is the “challenge of the clinician” to _____________ & treat within their scope of practice and to _____ within their ability or referral range

Answer 1

discover all the problems; offer solutions

Question 2

Describe some aspects to a lesion being of endodontic origin: (5)

Answer 2

1. pain
2. swelling
3. percussion sensitive
4. radiolucency
5. increased probing

Question 3

Describe sone aspects to a lesion being of periodontal origin: (5)

Answer 3

1. pain
2. swelling
3. percussion sensitive
4. radiolucency
5. increased probing

Question 4

What factors are common between a lesion being of endodontic origin as well as periodontal origin?

Answer 4

1. pain
2. swelling
3. percussion sensitive
4. radiolucency
5. increased probing

Question 5

Remember, periodontal health, function & stability is one of the basic requirements for any tooth being considered for:

Answer 5

endodontic treatment (as well as restorability & esthetics)

Question 6

Regularly, any combination of multiple challenges of a tooth (endo & perio) will: (3)

Answer 6

1. increase the difficulty
2. reduce the prognosis
3. limit the outcome of treatment

Question 7

Involvement of endo and perio in the same tooth results in:

Answer 7

lesser prognosis than either disease alone

Question 8

T/F: Endo is involvement is almost always the limiting factor

Answer 8

False- perio involvement is almost always the limiting factor

Question 9

What do you need prior to beginning any treatment if you suspect endo & perio involvement: (4)

Answer 9

1. endo pulpal diagnosis
2. periapical diagnosis
3. periodontal diagnosis
4. periodontal prognosis (idea)

Question 10

Irritants from diseases pulp may pass through ____ into periodontal tissues

Answer 10

lateral canals

Question 11

lateral canals are also called:

Answer 11

accessory canals

Question 12

T/F: Most often lateral (accessory) canals are NOT visible radiographically but are discovered following obturation

Answer 12

True

Question 13

How often do we see lateral (accessory) canals in molars?

Answer 13

23-76%

Question 14

What is a natural protective barrier of the tooth/root?

Answer 14

cementum

Question 15

____% of people have a VOID in the cementum at the CEJ

Answer 15

18-25%

Question 16

Any void of cementum (or enamel) via agenesis, injury or aggressive SRP will:

Answer 16

expose dentinal tubules & pulp to attach from micro-organisms

Question 17

List some causes of cemental agenesis or loss:

Answer 17

1. tooth brush abrasion
2. erosion
3. bulimia & other destructive habits
4. bruxism
5. trauma

Question 18

Cementum is thinnest or missing at:

Answer 18

CEJ

Question 19

Iatrogenic pathways of communication are problems that:

Answer 19

we create as endodontic perforations or post perforations

Question 20

Endodontic perforations or post perforations that we create during treatment is considered:

Answer 20

iatrogenic

Question 21

With any problem we create as endodontic perforations or post perforations, the prognosis:

Answer 21

suffers

Question 22

Where do we see multiple easy pathways of communication?

Answer 22

Between pulp and periodontium

Question 23

T/F: You are rarely dealing with the pulp or peridontium alone

Answer 23

False- you are NEVER dealing with the pulp or periodontium alone

Question 24

You are NEVER dealing with the PULP or PERIODONTIUM alone. Both must be a consideration in:

Answer 24

all treatments

Question 25

Any anomaly or injury providing access to the dentinal tubules also provides:

Answer 25

noxious access to the pulp

Question 26

If the anomaly or injury is apical to the gingival attachment, both:

Answer 26

the pulp and periodontium are involved

Question 27

If the anomaly or injury is _____, both the pulp and periodontium are involved

Answer 27

apical to the gingival attachment

Question 28

What type of fracture is often invisible on radiographs?

Answer 28

Vertical root fracture (VRF)

Question 29

What type of fracture is commonly visible on radiographs?

Answer 29

Horizontal root fracture (HRF)

Question 30

If you notice a J-shaped lesion and a drop-off pocket on the radiograph, you most likely are dealing with:

Answer 30

VRF

Question 31

Dens en Dente=

Answer 31

Developmental groove

Question 32

What is the success and survival of endodontically treated cracked teeth with radicular extensions?

Answer 32

90.6% success rate after 2-4 years

Question 33

What are the five classifications of Endo-Perio lesions?

Answer 33

1. Pure endo (Primary endo lesion) 2. Pure perio (Primary perio lesion) 3. Endo-Perio (Primary endo with secondary perio involvement) 4. Perio-Endo (Primary perio with secondary endo involvement) 5. "True" combined lesion (Combined vs. Conomitant perio & endo involvement)

Question 34

A PURE ENDO lesion:

Answer 34

Primary endo lesion

Question 35

A PURE PERIO lesionL

Answer 35

Primary perio lesion

Question 36

Endo-perio lesion:

Answer 36

Primary endo with secondary perio involvement

Question 37

Perio-endo lesion:

Answer 37

Primary perio with secondary endo involvement

Question 38

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

Answer 38

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

Question 39

T/F: Perio involvement decreases the prognosis (as opposed to endo involvement)

Answer 39

True

Question 40

Properly selected endo cases will have a ____% success rate (largely regardless of the cooperation of the patient)

Answer 40

90+%

Question 41

Perio success rate depends largely on the ability to:

Answer 41

motivate the patient

Question 42

Classifications of the endo-periodontal lesion include: (2)

Answer 42

1. eddo-periodontal lesion WITH root damage 2. endo-peridontal lesion WITHOUT root damage

Question 43

The classification "endo-peridontal lesion WITHOUT root damage" can be further divided into:

Answer 43

A) Endo-periodontal lesion in PERIODONTITIS patients B) Endo-periodontal lesion in NON-PERIOTONTITIS patients

Question 44

A pure endo case, results form a:

Answer 44

primary endo lesion

Question 45

Which of the five categories has the best prognosis? 1. Pure endo (Primary endo lesion) 2. Pure perio (Primary perio lesion) 3. Endo-Perio (Primary endo with secondary perio involvement) 4. Perio-Endo (Primary perio with secondary endo involvement) 5. "True" combined lesion (Combined vs. Conomitant perio & endo involvement)

Answer 45

Pure endo (primary lesion)

Question 46

With a pure endo lesion, what treatment is indicated?

Answer 46

RCT Only

Question 47

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 _______

Answer 47

pulpal injury; periodontal disease and loss of bone.

Question 48

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

Answer 48

drainage tract

Question 49

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)

Answer 49

True perio pocket; DST

Question 50

T/F: A true perio pocket can be seen with a primary endo lesion

Answer 50

False

Question 51

The clinical pulpal diagnosis for a PURE ENDO lesion indicates:

Answer 51

Necrotic pulp

Question 52

A PURE ENDO lesion often has a _____ onset with evidence of _____

Answer 52

rapid; pulpal damage (caries, trauma, etc.)

Question 53

With a PURE ENDO lesion in molar teeth, the furcation area nay appear to have:

Answer 53

1. significant bone loss 2. minimal to no calculus 3. no evidence of generalized or advanced periodontitis

Question 54

T/F: With a PURE ENDO lesion, the tooth may be mobile or exhibit a narrow channel sinus tract via a sulcus

Answer 54

True

Question 55

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

Answer 55

Pure endo (primary endo lesion)

Question 56

The prognosis of a PURE PERIO lesion:

Answer 56

totally dependent upon perio treatment success and motivation of patient

Question 57

With a PURE PERIO lesion, the treatment is limited to:

Answer 57

periodontal therapy only

Question 58

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

Answer 58

causative factors; meticulous self-care

Question 59

With a PURE PERIO lesion, clinical & radiographic assessments indicate:

Answer 59

-generalized, moderate to deep bony pockets (cone-shaped & wide) -calculus present -diffuse inflammation -asymptomatic patient -pulp response to sensibility testing WNL

Question 60

Can calculus typically be seen on an exam with a patient with a PURE PERIO lesion?

Answer 60

yes

Question 61

What symptoms will the patient present with if they have a PURE PERIO lesion? What are the results of pulp testing?

Answer 61

Asymptomatic patient; pulp responds to sensibility testing WNL

Question 62

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

Answer 62

Pure perio (primary perio lesion)

Question 63

T/F: With PURE PERIO lesion, there may be caries and injury to the pulp

Answer 63

false- no caries nor injury to the pulp

Question 64

What is the primary cause of an ENDO-PERIO lesion? What is the secondary cause?

Answer 64

Primary: endo Secondary: perio involvement

Question 65

What is the prognosis for Endo-Perio lesions?

Answer 65

guarded to poor prognosis

Question 66

What aspect makes the prognosis for an ENDO-PERIO lesion guarded to poor?

Answer 66

Perio involvement

Question 67

What treatment is indicated for an ENDO-PERIO lesion?

Answer 67

Both RCT and periodontal treatment

Question 68

Both an RCT and Periodontal treatment are indicated for Endo-Perio lesions. Simultaneous end and perio management is preferable. ____ first and then _____.

Answer 68

RCT; Perio

Question 69

T/F: With an ENDO-PERIO lesion, simultaneous endo and perio management is preferable

Answer 69

True

Question 70

With an ENDO-PERIO lesion, what should come first- RCT or perio therapy?

Answer 70

RCT

Question 71

The prognosis for resolution of ENDO-PERIO lesion is dependent upon ability to:

Answer 71

Treat BOTH entities successfully

Question 72

What is the difference in pockets for a PURE PERIO lesion vs. ENDO-PERIO lesion?

Answer 72

PURE PERIO: Moderate deep bony pockets (cone-shaped & wide, calculus present) ENDO-PERIO: Unusual deep pockets; little or no calculus present

Question 73

The clinical pulpal diagnosis for an ENDO-PERIO lesion indicates:

Answer 73

necrotic pulp

Question 74

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

Answer 74

Endo-perio lesion

Question 75

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?

Answer 75

Endo-perio lesion