THE ENDODONTIC-PERIODONTIC LESION: A DIAGNOSTIC DILEMMA

Question 1

infection from the PDL to pulp

Answer 1

pathogenic bacteira and inflammatoru products of periodotnal disease

• moves throuh accessory canals/lareral canals apical foramtion
• leads to pulpal infeciton/necrosis

Question 2

classificaiton of perio endo lesions

Answer 2

primary endo, seconday perio
primary perio, secondary endo

true combinaed lesion

Question 3

primary endo secondary perio lesion

Answer 3

• originally an endo lesion, infection spread from apex and along root to gingiva
• pupal infection can also spread from accessory canals to the gingiva or furcation
• primary endo lesions will have started as pulpal, to periapical infection (with radiolucency)
  following this

Question 4

how would chronic apical periodontitis drain

Answer 4

infection will drain via sinus tract

Question 5

primary perio secondary endo

Answer 5

Periodontal pocket can deepened to the apex and secondarily involved the pulp
- alternatively a periodontal pocket can infect the pulp through a lateral canal (more common by apical region)

Question 6

true combined

Answer 6

Two independent lesions (periapical and periodontal) can coexist and eventually fuse with each other.
- periodontal disease and a non vital tooth which has developed periapical periodontitis

Question 7

other classifications than the origional

Answer 7

1) concurrent endodontic and periodontal disease without communication
2) concurrent endodontic and periodontal disease with communication

Question 8

commincating vs non communicating

Answer 8

• non communicating lesions suggest a true combined lesion with independent aetiologies

Question 9

communicating lesions

Answer 9

• lesions which have stated primarily as endo or perio and then spread to the other
• knowing the org source of infection can have implication for management and prognosis of the case

Question 10

J shaped lesion can indicate

Answer 10

combo of periodontal picketing and periapical pathologu

or vertical root fracture

Question 11

tx of these lesions

Answer 11

1 endo 1 perio - RCT
2 endo 2 perio - RCT and perio therapy
true combined - RCT and Peroo

Question 12

rationale for just endo for 1 endo 2 perio lesion

Answer 12

endo infection just happens to be draining via PDL

Question 13

alternative managment options

Answer 13

• CaOH in canal rather than obturating whilst assessing response to perio therapy
• obturation only undertaken once response seen
• maintains ability to keep open and reclean

Question 14

lesiosn which can appear as perio endo lesions

Answer 14

1) developmental grooves
2) perforations
3) root fracturs
4) resorption

Question 15

tx for perforation

Answer 15

• un restorable – tooth requires extraction
• if restorable, repair of perforation either internally or externally using a biocompatible material such as MTA or biodentine
• mg best undertaken by an endodontics

Question 16

external replacement resoprtion

Answer 16

Root surface gradually replaced with bone (ankylosis)

Question 17

internal root resoption

Answer 17

rs entirely within the canal system

• results in an ovoid expansion of the RC
• outline of canal will be lost around area of resorption
• pulp will likely be chronically inflamed
• pink spot lesion may be visible through enamel
• tooth usually partially vital and symptoms of pulpitis

Question 18

mg of internal root resorpition

Answer 18

• provided tooth is restorable endodontic treatment required
• obturation may be difficult due to unusual canal anatomy
• thermal obturation techniques (backfill with molten GP) is required to fill lesion properly