Lecture 6: Endodontic-Periodontal Relationships Flashcards
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
Describe some aspects to a lesion being of endodontic origin: (5)
- pain
- swelling
- percussion sensitive
- radiolucency
- increased probing
Describe some 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 to a tooth (endo & perio) will: (3)
- increase the difficulty
- reduce the prognosis
- limit the outcome of treatment
Involvement of endo and period in the same tooth results in:
less prognosis than either disease alone
T/F: Endo 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?
- endo pulpal diagnosis
- endo periapical diagnosis
- periodontal diagnosis
- periodontal prognosis (idea)
Irritants from diseased pulp may pass through ____ into periodontal tissues
lateral canals
T/F: Most often lateral (accessory) canals are NOT visible radiographically but are discovered following obturation:
True
Lateral canals are also called:
accessory canals
How often do we see lateral canals in molars?
23-76%
What is a natural protective barrier of the tooth/root?
cementum
___% of people may have a VOID in the cementum at the CEJ
18-25%
Any void of cementum (or enamel) via genesis, injury, or aggressive SRP will:
expose dentinal tublues & pulp to attach from micro-organisms
Cementum is thinnest or missing at:
CEJ
List some reasons to have areas of cemental agenesis or loss: (5)
- tooth brush abrasion
- erosion
- bulemia & other destructive habits
- bruxism
- trauma
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
Note- there are multiple easy pathways between the:
pulp and periodontium
T/F: You are rarely dealing with the pulp or periodontium 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 considered in:
all treatment
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?
- 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. 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:
- Endo-periodontal lesion with root damage
- 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?
- 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. 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:
- 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 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
