Perio-Endo and Cracks Flashcards
Main pathway of communication from the pulp to the periodontium.
Apical foramen
These are more common in the posterior teeth than anterior, and apical than coronal.
Lateral canals.
t/f:
Periodontitis adjacent to a lateral canal does NOT induce pulpitis.
True
Size and number of these decrease as you go in an apical direction.
Dentinal tubules
Acts as a barrier between pulp and periodontium
Cementum
t/f:
Most studies show that periodontitis has little to no effect on the pulp.
True
Periodontal DISEASE does not affect the pulp, but periodontal _______ can cause pulpitis/necrosis.
TREATMENT
- Necrotic
- Sinus tract drains thru the sulcus.
- NARROW pocket
1 endo lesion
- Vital pulp
- Wide pocket on probin
1 perio lesion
- Necrotic pulp
- Sinus tract drains through the sulcus.
- Plaque and calculus present.
- -Results in a wider pocket.
1 endo + 2 perio
- Vital or necrotic pulp
- Perio pocket extends to the lateral canal or foramen
- Results in pulpitits (retrograde) and eventually necrosis
- prognosis depends on perio tx.
1 perio + 2 endo
Prognosis for 1 perio + 2 endo depends on what tx?
Perio
- Separate endo and perio lesions meet.
- Extensive bony destruction.
- Wide defects.
- Prognosis depends on perio tx.
True combined lesion
- Separate endo and perio lesions that do NOT meet.
- Don’t influence each other.
- Both diseases must be treated separately.
- Prognosis depends on perio tx.
Concomitant perio-endo lesions.
What does the prognosis of the tooth depend on when moderate to severe periodontitis exists?
Perio treatment
Occur in a vertical direction AND over time.
Longitudinal tooth fractures.
Longitudinal fractures confined to the enamel
Seen in the B and L marginal ridge of posterior teeth, and the cervical to incisal edge of anterior teeth.
Craze lines
- Occurs from loss of cusp support (large restorations or extensive caries)
- Crack lines cross the marginal ridge and extend down the buccal or lingual.
Cusp fracture
- Oblique shearing fracture at the line angle at the base of the cavity.
- Pain on release.
- Usually don’t involve the pulp
Tx: Remove fractured cusp and restore.
Cusp fracture
Incomplete (greenstick) fracture initiated from the crown and extends apically
- Usually mesio-distally.
- Can propogate down the root surface..
Cracked tooth
Most common teeth involved in cracked tooth:
Mand 2nd molar > Mand 1st molar > Max Pm’s = Max molars
- Acute pain on mastication.
- Brief pain to cold.
Signs and symptoms are variable, so we don’t use this term anymore.
Cracked tooth syndrome
t/f:
Poorer prognosis if the crack extends through or beyond the pulp chamber floor or if there’s deep probing.
True
- Evolution of a crack
- A complete fracture
- Separate segments
- Usually involves the pulp
Split tooth
What do you do if the split reaches the apical 1/3 of the tooth?
Exo!
What to do if the split reaches the middle or coronal 1/3?
Remove smaller segment and salvage the larger one
- Occur in the BL direction
- Result from wedging forces within the canal
- Beings internally and grows outward
- Propagates apical to coronal.
Vertical root fracture
Two major causes of vertical root fracture.
1) Post placement
2) Condensation during root canal filling
Rarely in non-endodontically treated teeth, but seen in Chinese population.
Vertical root fracture.
Avoid these posts to prevent vertical root fracture.
Active and cast
What percent of VRF’s are not prebeble?
60
Radiographic appearance of vertical root fractures.
J-shaped RL
Bone loss pattern associated with vertical root fractures.
Dehiscence or Fenestration
A narrow, vertical defect in the alveolar plate of bone over a root extending from the crestal area apically.
Dehiscence
A window-like opening in the alveolar plate of bone frequently exposing a portion of the root.
Fenestration
