Lecture 6: Endodontic-Periodontal Relationships Flashcards by Abagayle Moody

It’s 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

How well did you know this?

Not at all

Perfectly

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

pain
swelling
percussion sensitive
radiolucency
increased probing

How well did you know this?

Not at all

Perfectly

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

pain
swelling
percussion sensitive
radiolucency
increased probing

How well did you know this?

Not at all

Perfectly

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

pain
swelling
percussion sensitive
radiolucency
increased probing

How well did you know this?

Not at all

Perfectly

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

endodontic treatment (as well as restorability & esthetics)

How well did you know this?

Not at all

Perfectly

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

increase the difficulty
reduce the prognosis
limit the outcome of treatment

How well did you know this?

Not at all

Perfectly

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

less prognosis than either disease alone

How well did you know this?

Not at all

Perfectly

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

False- Perio involvement is almost always the limiting factor

How well did you know this?

Not at all

Perfectly

What do you need prior to beginning any treatment if you suspect endo & perio involvement?

endo pulpal diagnosis
endo periapical diagnosis
periodontal diagnosis
periodontal prognosis (idea)

How well did you know this?

Not at all

Perfectly

Irritants from diseased pulp may pass through ____ into periodontal tissues

lateral canals

How well did you know this?

Not at all

Perfectly

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

True

How well did you know this?

Not at all

Perfectly

Lateral canals are also called:

accessory canals

How well did you know this?

Not at all

Perfectly

How often do we see lateral canals in molars?

23-76%

How well did you know this?

Not at all

Perfectly

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

cementum

How well did you know this?

Not at all

Perfectly

___% of people may have a VOID in the cementum at the CEJ

18-25%

How well did you know this?

Not at all

Perfectly

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

expose dentinal tublues & pulp to attach from micro-organisms

How well did you know this?

Not at all

Perfectly

Cementum is thinnest or missing at:

CEJ

How well did you know this?

Not at all

Perfectly

List some reasons to have areas of cemental agenesis or loss: (5)

tooth brush abrasion
erosion
bulemia & other destructive habits
bruxism
trauma

How well did you know this?

Not at all

Perfectly

Iatrogenic pathways of communication are problems that:

we create as endodontic perforations or post perforations

How well did you know this?

Not at all

Perfectly

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

Iatrogenic

How well did you know this?

Not at all

Perfectly

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

suffers

How well did you know this?

Not at all

Perfectly

Note- there are multiple easy pathways between the:

pulp and periodontium

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

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

all treatment

How well did you know this?

Not at all

Perfectly

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 a 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 extension?

90.6% after 2-4 years

What are the five classifications of Endo-Perio Lesions?

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. Concomitant perio & endo involvement)

A PURE ENDO lesion:

Primary Endo Lesion

A PURE PERIO lesion:

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 patient cooperation) However, Perio success depends largely 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 ____ percentage success rate (largely regardless of the cooperation of the patient)

90+

Perio success depends largely on the ability to:

motivate the patient

Classifications of Endo-periodontal lesions include:

1. Endo-periodontal lesion with root damage 2. Endo-periodontal lesion without root damage

The classification "Endo-periodontal lesion WITHOUT root damage" can be further divided into:

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

A pure endo case, results from a:

primary endo lesion

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. Concomitant perio & endo involvement)

Pure endo (primary endo lesion)

With a Pure endo lesion, what treatment is indicated?

RCT only

With a pure endo diagnosis, a ____ initiates forthcoming LEO. Extension or the pulpal inflammation precedes to the canals, out the apex and irritates the periodontium (P/A tissues) creating _____.

pulpal injury; periodontal disease and loss of bone

With a pure endo lesion, a ____ originating from the apex or a lateral canal may form along the root surface and exit via the gingival sulcus.

Drainage Tract

With a pure endo lesion, 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 _____. Also is NOT a classic ____ but it 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 and evidence of ____.

rapid onset; pulpal damage (caries or trauma)

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

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

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

True

Diagnose- Your patient presents to the clinic with: - Swelling present in attached gingiva - Soreness of tooth with biting down - They state this had a very rapid onset Upon examination, you note: - tooth mobility - pulp diagnosis of necrotic pulp - caries present on the tooth in question - minimal calculus and healthy gum tissue - bone loss in furcation area of tooth

Pure endo (primary endo)

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 deep bony pockets (cone-shaped & wide) - calculus present - diffuse inflammation - asymptomatic pt - pulp responds to sensibility testing WNL

Describe the inflammation seen with a PURE PERIO lesion:

diffuse inflammation

Describe the bony pockets seen with a PURE PERIO lesion:

generalized, moderate, deep bony pockets that are cone shaped and wide

Can calculus typically be seen on 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 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 a 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 causes?

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 Endo-Perio lesions?

Both RCT & Periodontal Tx

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

RCT; perio

T/F: For an Endo-perio lesion, simultaneous endo and perio management is preferred

True

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

RCT!

The prognosis for resolution of an Endo-perio lesion is dependent upon ability to:

Treat BOTH entities successfully

What type of pockets should you be on the lookout for when determining if it is an endo-perio lesion?

unusual deep pockets with little or no calculus

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

Pure- perio: moderate deep bony pockets (cone shaped & wide) with 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 clinic with: - Evidence of periodontal disease around the tooth in question - Vertical bone loss - inflamed gingiva around tooth in question - little to no calculus - no generalized periodontitis

Endo-Perio Lesion

Your patient presents to clinic and you note radiographic changes in the pulpal space visible with linear or isolated calcific changes. Whats a potential diagnosis?

Endo-perio lesion