Perio-endo lesions Flashcards
with a perio-endo lesion, do infections occur simultaneously or are they seperate?
separate
3 avenues of communication for pulp and peridontium
dentinal tubules
lateral and accessory canals
apical foramen
Tubules can loose the overlying cementum coverage by….
periodontal disease
scaling and root planning
surgical procedures
developmentally
Dentinal trivia
tubules are 1-3 micrometersin diameter
decrease in old age and response to inflammation
vary from 8000 at DCJ to 57000 at apical end
what % of max 2nd PM’s have lateral canals?
59.5%
78% of them are in apical region
what % of all teeth have lateral or accessory canals?
30-40%
a study showd that __% of accessory canals were in the furcation area.
__% in mand molars
__% in maxillary molars
__% had canals in furcation only
- 4%
- 4%
- 4%
- 5%
what is the most direct route of communication between pulp and peridontium?
apical foramen
advanced pulpitis leads to
pulp necrosis
where does resoprtion occur in chronic radicular abscess?
root apex
periodontal tissue breakdown is also known as…
retrograde periodontitis
retrograde periodontits starte where and moves in what direction?
apex and works cervically
orthograde periodontitis starts where and moves in what direction?
start in sulcular area and moves apically
T/F, early inflammation has a large effect on peridontium
F, initial inflammation actually is trying to prevent it from spreading
T/F when tissue is necrotic the inflammation can spread to surrounding peridontium?
T,
it spreads through foramen, accessory canals and dentin tubules
what bacteria pathogens cause inflammatory response in peri-endo lesions?
Aggregatibacter actionmycetemcomitans.
Tannerella forsythensis. Fusobacterium nucleatum. Porphyromonas gingivalis. Prevotela intermedia. Eikenella corrodens
whats the predominant spirochete found in inflammation?
treponema denticola
whats the fungi predominant in inflammation?
candida albicans
whats the virus predominant in inflammation?
epstein-barr virus
human cytomegalovirus as well
what are some contributing factors to perio-endo lesions?
poor restorations-
root canals can get contaminated by delaying placement of crown
improper space for posts
inadequate seal from endo procedure.
what kinds of trauma can contribute to perio-endo lesions?
crown fractures
crown root fractures
vertical fractures
oblique and horizontal fratures
trauma resulting in vertical fractures ranges from
3.69-10.99%
Resorption is defined as
physiologic or pathologic process resulting in a loss of dentin, cementum, and or bone
what are the types of resoprtions?
external resorption
internal resorption
replacement resorption
resoprtion is usually associated with what?
trauma
but also occurs with orthodontics, tumors, cysts, pulpal inflammation and perio disease
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….
patientes symptoms coronal integrity shape and size of radiographic lesions perio probing tooth vitality
reversible pulpitis can be treated by…
adjusting occlusion, retreating faulty restorations, closing exposed tubules
urreversible pulpitis leads to ____ and has sharp un-triggered pain.
necrotic pulp
Patients objective symptoms include…
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
coronal integrity of perodontal infections vs endodontic infections
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
Radiographs are ___ data but the interpretaion of them is ______
objective, subjective
Vitality of perio-endo lesions
teeth with perio infection alone test vital while perio-endo dont
vitality with irreversible pulpitis
usually have lingering pain to thermal testing and sometimes get relief from cold stimulus
vitality with reversible pulpitis
these pts have a quick response to hot or cold( 5-10sec)
2 main factors in considering your treatment are
pulp vitality
extent of periodontic defect
primary endodontic infection
( advanced pulpitis)
only endo
primary periodontal infection
only perio
perio-endo infection
involves both endo and perio
primary endodontic infection with secondary periodontal involvment means what?
that endo is the cause of the perio issues. So if this Pt had endo done, the perio issue should clear up
after performing endo on a person with primary endo infection with secondary perio infection, how long do you wait to re-evaluate?
2-3 months
this time allows for healing
what is considered a “true” perio-endo lesion?
when periodotnal disease is causing the endodontic problem
ture perio-endo lesions require what for therapy
both endodontic and periodontal therapies
