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Periodontology > The endodontic-periodontic lesion > Flashcards

The endodontic-periodontic lesion Flashcards

1
Q

How do you get a perio-endo infection?

A

Get infection from the PDL going into the pulp - the pocket can extend to the apex of the tooth or via a lateral canal bacteria gains access to the pulp
Then get pulpitis -> periapical pathology

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2
Q

What is the steps to getting pulpal infection/necrosis from perio disease?

A

Pathogenic bacteria and inflammatory products of perio disease -> accessory canals/apical foramen -> pulpal infection/necrosis

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3
Q

What are the steps for getting infection from the pulp to the PDL?

A

Pulpal disease/procedural errors in RCT/ Perforations/ vertical root fractures -> Dentinal tubules/peri-radicular inflammation -> bone loss +/ CAL + / pus discharge

Rather than draining into a sinus, it drains through the PDL - get periodontitis

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4
Q

What is a primary endo, secondary perio lesion?

A

Originally an endo lesion, the infection spreads from the apex along the root to the gingiva
Pulpal infection can also spread from accessory canals along the gingiva or furcation

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5
Q

What is a primary perio, secondary endo lesion?

A

A periodontal pocket can deepen to the apex and secondarily involve the pulp
Alternatively, a perio pocket can infect the pulp through a lateral canal

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6
Q

What is a true combined lesion?

A

2 independent lesions (periapical and periodontal) can coexist and eventually fuse with each other - the 2 may or may not combine

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7
Q

What other classification of a true combined lesion allows you to decide where the original source of the infection is from

A

Whether on a radiograph the endodontic and periodontal lesions have communication or not

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8
Q

How does knowing whether the lesions are communicating suggest?

A

Non-communicating suggests the true combined lesion has independent aetiologies

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9
Q

What are the possible options for how a combined lesion started?

A

May be true combined which have merged or lesions that started as perio or endo and then spread to the other

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10
Q

What does knowing the original source of the infection allow?

A

Can have an implication for the management and prognosis of the case

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11
Q

How do you get to a diagnosis?

A

History
Examination
Special tests
Other tests

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12
Q

What is involved in an endodontic examination?

A

Restorative status - whether restorable
TTP
Tenderness in sulcus
Swelling/sinus

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13
Q

What is involved in a periodontal examination?

A

Probing around the tooth - easy to miss
Pus discharge from the pocket
Mobility

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14
Q

What are the 2 sensibility tests?

A

Cold testing
EPT
Need to be negative to both to confirm it is non-vital

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15
Q

What is the most appropriate radiograph to take?

A

Periapical

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16
Q

What is seen on the radiogrpah?

A

A vertical periodontal defect often present
A radiolucency around the apex
A J-shaped lesion may be present - bone loss that extends down the root and around the apex, but only on one side

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17
Q

When would an OPT be used?

A

if multiple sites needed to be radiographed - for periodontal assessment

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18
Q

When would a CBCT scan be indicated?

A

When conventional radiography does not provide sufficient detail
e.g. complex 3D anatomy or suspicion of other causes; resorption or perforation

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19
Q

What other tests can be done?

A

Consider tooth sleuth and transillumination to rule out root fracture
Teeth with fractures and cracks are present with J shaped lesions and non-vital pulp

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20
Q

What symptoms may you associate with a perio-endo lesion

A 
Swelling of the gingiva
Pus discharge
Pocket formation
Fistula tract (sinus)
TTP
Mobility
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21
Q

What is the treatment for primary endo, secondary perio lesion?

A

RCT only

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22
Q

What is the treatment for primary perio secondary endo lesion?

A

RCT and periodontal therapy

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23
Q

What is the treatment for true combined leisons?

A

RCT and periodontal therapy

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24
Q

What is the rationale for primary endo, secondary perio lesions

A

They have an endodontic aetiology: dead pulp and periapical infection draining down the PDL - if do RCT the sinus will heal up, then get reattchment of the PDL

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25
Q

What is the appearance of the perio lesion due to primary endo infection?

A

Usually presents as a narrow defect - narrow, not conductive to instrumentation

26
Q

When do you review the perio lesion?

A

After 3 months, instigate non-surgical periodontal therapy if the pocketing is still present
If after another 3 months, no resolution, then consider surgical intervention, may need to lift flap

27
Q

What is the rationale for primary perio, secondary endo lesions

A

Has a periodontal aetiology but tooth has become non-vital so requires RCT
Have a deep perio pocket established perio disease caused an endo infection
Both therapies are required - best to undertake these simultaneously - to eradicate as much bacteria in one go as possible

28
Q

When do you review the primary perio, secondary endo lesions?

A

3 months and instigate further non-surgical periodontal therapy if the pocketing is still present
Review after another 3 months, if still no resolution, then consider surgical intervention or reconsider diagnosis

29
Q

What is the rationale for the treatment of a true combined lesion?

A

Have both a perio and an endo aetiology
Need to treat the perio and endo - best to do this simultaneously
Review after 3 months

30
Q

What is an alternative management option for perio-endo lesion involving calcium hydroxide?

A

Place calcium hydroxide inside the prepared canal rather than obturating whilst assessing the response to periodontal therapy
do the periodontal therapy, if this has worked, can then obturate after

31
Q

Is this method better?

A

No evidence to suggest this is more effective

32
Q

What other alternative to management of perio-endo lesion?

A

Surgical intervention may be indicated earlier if have very deep pockets not conductive to non-surgical periodontal therapy

33
Q

what is an involvement for management if the tooth is a molar?

A

If one root is more affected than the other can do root-resction or hesmisection on that root and do RCT on the root youre keeping.
The root will support the tooth if there is enough bone around it

34
Q

What is a root resection

A

just the root is removed

Is taken on the mesio-buccla or disto-buccal roots of the molar

35
Q

What is a hemisection?

A

Section of the tooth is removed as well as as the root

Undertaken on lower molars

36
Q

What are the prognosis’ of each one?

A

Primary endo = good

Primary perio and true combined = prognosis depends on extend of periodontal bone loss

37
Q

What can developmental grooves lead to?

A

Can predispose to formation of a deep periodontal pocket which can extend to the apex, if untreated cab result in pulp death

38
Q

How do you manage a periodontal pocket developed from a developmental groove?

A

Endodontic treatment
and periodontal therapy, surgery may be required due to the groove - surgical bone removal to expose the defect, repair it, add biogide

39
Q

What is biogide?

A

Synthetic bone and collagen to repair the bone in the area

40
Q

When can perforations occur?

A

During endodontic treatment, placement of an endodontic post or dentine pin

41
Q

What can perforations give the appearance of?

A

Perio-endo lesion as infection will develop around the perforation site and may drain through the pocket that forms via the PDL

42
Q

How can the perforation appear clinically?

A

Deep pocket leading to the site of perforation

43
Q

How does the perforation appear radiograpically?

A

Leads to bone loss, may be radiographically visible

44
Q

What is the management of a perforation

A

Assess the restorability of the tooth
if restorable, the tooth will require repair of perforation internally or externally using a biocompatible material: MTA or biodentine
Undertaken by an endodontist

45
Q

How may a fracture present?

And radiographically

A

Similar to perio-endo lesion: narrow, deep, isolated periodontal pocket
A J shaped lesion radiographically

46
Q

What is the management of a fracture?

A

Need to assess the extent of the facture
Vertical fracture that extends on to the root face will require extraction
If only extends to the ACJ - then still restorable

47
Q

What are the different root resorption?

A

External: cervical resorption, replacement resorption

Or internal

48
Q

What is the aetiology of external cervical root resorption?

A

unknown
Orthodontics/internal bleaching/trauma
Dentinoclasts form on the outside of the tooth if have lost some cementum

49
Q

Where does external cervical root resorption start?

A

Subgingivally in the cervical region

50
Q

How does external cervical root resorption present clinically?

A

Pulp is vital
Asymptomatic
pocketing may be present around the tooth - not deep because fills with gingival tissue

51
Q

How does external cervical root resorption present radiographically?

A

Mottled appearance just below bone level

52
Q

What is the treatment of external cervical root resorption?

A

Surgical exploration followed by repair

May or may not need endo treatment

53
Q

What is the surgical treatment of external cervical root resorption?

A

if extends into the pulp,
need to keep the canal patent by putting in a GP, then put restoration, go back and do the RCT
Or can repair internally first with some MTA, do the RCT then do the restoration

54
Q

How would an internal lesion appear radiographically?

A

The root canal will balloon out and lose the line of the root canal

55
Q

What is external replacement resorption?

A

Root surface is gradually replaces with bone = ankylosis

Can be self-limiting and transient but will progress until complete root replacement occurs

56
Q

How does external replacement resorption present clinically?

A

A catch present at the gingival margin - mimic perio-endo
mottled appearance on the whole root surface
High pitched, metallic sound on percussion

57
Q

What is internal root resorption?

A

Occurs within the canal system, results in ovoid expansion of the root canal
The outline of canal is lost around area of resorption

58
Q

How does internal root resorption appear clinically?

A

Pulp will be chronically inflamed,

A pink spot lesion will appear through the enamel

59
Q

In internal root resorption the tooth is partially vital what symptoms does the patient feel and why?

A

Symptoms of pulpitis
Vital tissue needed to form the dentinoclasts to eat away
Nectrotic pulp acts as a source of irritant - then the whole pulp dies
It can stop before it penetrates

60
Q

What can happen if the internal root resorption continues to expand and perforates the root?

A

a periodontal lesion may form

61
Q

What obturation technique is used to fill the root canal that has been resorbed internally?

A

Thermal obturation - backfill with molten GP

If expanded to extent that has perforated the side of tooth, has poor prognosis

Periodontology (7 decks)

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