Perio-endo lesions

Question 1

with a perio-endo lesion, do infections occur simultaneously or are they seperate?

Answer 1

separate

Question 2

3 avenues of communication for pulp and peridontium

Answer 2

dentinal tubules
lateral and accessory canals
apical foramen

Question 3

Tubules can loose the overlying cementum coverage by….

Answer 3

periodontal disease
scaling and root planning
surgical procedures
developmentally

Question 4

Dentinal trivia

Answer 4

tubules are 1-3 micrometersin diameter
decrease in old age and response to inflammation
vary from 8000 at DCJ to 57000 at apical end

Question 5

what % of max 2nd PM’s have lateral canals?

Answer 5

59.5%

78% of them are in apical region

Question 6

what % of all teeth have lateral or accessory canals?

Answer 6

30-40%

Question 7

a study showd that __% of accessory canals were in the furcation area.
__% in mand molars
__% in maxillary molars
__% had canals in furcation only

Answer 7

28. 4%
29. 4%
30. 4%
31. 5%

Question 8

what is the most direct route of communication between pulp and peridontium?

Answer 8

apical foramen

Question 9

advanced pulpitis leads to

Answer 9

pulp necrosis

Question 10

where does resoprtion occur in chronic radicular abscess?

Answer 10

root apex

Question 11

periodontal tissue breakdown is also known as…

Answer 11

retrograde periodontitis

Question 12

retrograde periodontits starte where and moves in what direction?

Answer 12

apex and works cervically

Question 13

orthograde periodontitis starts where and moves in what direction?

Answer 13

start in sulcular area and moves apically

Question 14

T/F, early inflammation has a large effect on peridontium

Answer 14

F, initial inflammation actually is trying to prevent it from spreading

Question 15

T/F when tissue is necrotic the inflammation can spread to surrounding peridontium?

Answer 15

T,

it spreads through foramen, accessory canals and dentin tubules

Question 16

what bacteria pathogens cause inflammatory response in peri-endo lesions?

Answer 16

Aggregatibacter actionmycetemcomitans.

Tannerella forsythensis.
 Fusobacterium nucleatum.
 Porphyromonas gingivalis.
 Prevotela intermedia.
 Eikenella corrodens

Question 17

whats the predominant spirochete found in inflammation?

Answer 17

treponema denticola

Question 18

whats the fungi predominant in inflammation?

Answer 18

candida albicans

Question 19

whats the virus predominant in inflammation?

Answer 19

epstein-barr virus

human cytomegalovirus as well

Question 20

what are some contributing factors to perio-endo lesions?

Answer 20

poor restorations-
root canals can get contaminated by delaying placement of crown
improper space for posts
inadequate seal from endo procedure.

Question 21

what kinds of trauma can contribute to perio-endo lesions?

Answer 21

crown fractures
crown root fractures
vertical fractures
oblique and horizontal fratures

Question 22

trauma resulting in vertical fractures ranges from

Answer 22

3.69-10.99%

Question 23

Resorption is defined as

Answer 23

physiologic or pathologic process resulting in a loss of dentin, cementum, and or bone

Question 24

what are the types of resoprtions?

Answer 24

external resorption
internal resorption
replacement resorption

Question 25

resoprtion is usually associated with what?

Answer 25

trauma

but also occurs with orthodontics, tumors, cysts, pulpal inflammation and perio disease

Question 26

with a perio-endo lesion you need to have a differential diagnosis which determines the primary cause of the lesion. Coming up with the diagnosis should include….

Answer 26

patientes symptoms
coronal integrity
shape and size of radiographic lesions
perio probing
tooth vitality

Question 27

reversible pulpitis can be treated by…

Answer 27

adjusting occlusion, retreating faulty restorations, closing exposed tubules

Question 28

urreversible pulpitis leads to ____ and has sharp un-triggered pain.

Answer 28

necrotic pulp

Question 29

Patients objective symptoms include…

Answer 29

presentation of abseccess or fistula
palpation over tooth
pain on percussion
redness
radiographs
narrow probings usually indicate endodontic origin while broader probings indicate periodontal origin

Question 30

coronal integrity of perodontal infections vs endodontic infections

Answer 30

perio- doesnt usually involve the crown so the crown is absent of defects
endo- often is associated with coronal defects like caries, failing restorations, cracks

Question 31

Radiographs are ___ data but the interpretaion of them is ______

Answer 31

objective, subjective

Question 32

Vitality of perio-endo lesions

Answer 32

teeth with perio infection alone test vital while perio-endo dont

Question 33

vitality with irreversible pulpitis

Answer 33

usually have lingering pain to thermal testing and sometimes get relief from cold stimulus

Question 34

vitality with reversible pulpitis

Answer 34

these pts have a quick response to hot or cold( 5-10sec)

Question 35

2 main factors in considering your treatment are

Answer 35

pulp vitality

extent of periodontic defect

Question 36

primary endodontic infection

Answer 36

( advanced pulpitis)

only endo

Question 37

primary periodontal infection

Answer 37

only perio

Question 38

perio-endo infection

Answer 38

involves both endo and perio

Question 39

primary endodontic infection with secondary periodontal involvment means what?

Answer 39

that endo is the cause of the perio issues. So if this Pt had endo done, the perio issue should clear up

Question 40

after performing endo on a person with primary endo infection with secondary perio infection, how long do you wait to re-evaluate?

Answer 40

2-3 months

this time allows for healing

Question 41

what is considered a “true” perio-endo lesion?

Answer 41

when periodotnal disease is causing the endodontic problem

Question 42

ture perio-endo lesions require what for therapy

Answer 42

both endodontic and periodontal therapies