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DS4102 > W8 - Interdisciplinary Perio Part 2 - Sharma > Flashcards

W8 - Interdisciplinary Perio Part 2 - Sharma Flashcards

1
Q

What are the 3 main pathways of perio/endo pathology

A
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2
Q

How can the dentinal tubules be exposed iatrogenically?

A

Aggressive root planing

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3
Q

4 types of endo-perio lesions

A

this is prior to 2017 classification

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4
Q

Anatomical entities responsible for endo-perio lesions (6)

A

Lingual grooves

fractures

Root anomalies

Intermediate bifurcation ridges

Cervical enamel projections

Trauma-induced RR

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5
Q

How are perio-endo lesions described?

A

Primary _____ secondary ______

depends on what happened first

Can also be a true combined lesion (when hard to say what happened first)

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6
Q

What is the modern (2017+) endo-perio lesion classification

A
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7
Q
A
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8
Q

What determines a hopeless prognosis for a tooth with endo-perio lesion

A

EPLs associated with trauma or iatrogenic factors

(ex. perforation)

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9
Q

What determines a poor or favourable prognosis for a tooth with endo-perio lesion

A

EPLs associated with endodontic and periodontal lesions and depends on extent of periodontal involvement

  • (vs epls associated with trauma or iatrogenic factors which will have poor prognosis)
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10
Q

Describe the effect of pulpal disease on periodontium

A

If vital → no effect

Necrosis → bone resorp, PARL

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11
Q

3 endo procedures that can affect periodontium

A

Extirpation

Cleaning and shaping

Vert root fracture during obturation or post placement

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12
Q

How does periodontium get affected by endodontic shaping? (3)

A

Debris pushed into PFL

extension of files or filling materials

perforation of the pulp chamber floor

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13
Q

periodontal procedures that can affect pulp

A

Deep curettage → damage apical vessels

Scaling/debridement → remove cementum leading to open dentinal tubules and possibly lateral canals

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14
Q

How does a primary endodontic lesion present? (3)

A

Necrotic pulp with CAP and sinus tract that drains through the sulcus

Radiograph reveals isolated perio defect around individual tooth

no associated generalized perio

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15
Q

Investigations for primary endodontic lesion (2)

A

Negative pulp vitality test

Tracing tract with GP (leads to apex or mid root if lateral canal)

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16
Q

Treatment of primary endo lesions? Prognosis?

A

No debridement needed

RCT

Great prognosis → rapid and complete healing (3-6 months)

17
Q

How does a primary periodontal lesion present? (3)

A

May mimic an endodontic problem clinically and radiographically

Minimal - no pain with perio lesions

If it is painful, there may be coronal fracture that extends into PDL

18
Q

Clinical tests for primary periodontal lesions (2)

A

Periodontal pocket reaches apex

pulp testing is within normal limits (vital)?

19
Q

Treatment of primary periodontal lesions (3)

A

Periodontal therapy

RCT NOT INDICATED (unless pulp vitality changes)

Reevaluation after therapy to check for possible retrograde endodontic lesion

20
Q

Prognosis of primary periodontal lesions after treatment

A

Depends on quality of periodontal therapy

  • Teeth with perio attachment loss to the apex = not favourable prognosis
21
Q

Differential diagnosis of true combined lesion

A

Vertical Root Fracture

22
Q

Clinical tests for True Combined Lesion (3)

A

tooth not vital

Deep perio pockets at multiple sites around tooth

Radiograph with multiple gp points into sulcus tracing to apex

23
Q

Tooth is necrotic

A

primary endodontic lesion

  • note the isolated perio problem and sinus tract
24
Q

36 pocket extends to apex

A

primary periodontal lesion

25
Q

What is a Primary endodontic lesion with primary periodontal involvement?

Vitality?

Features?

Tx / prognosis?

A

Primary endodontic lesion with an independent periodontal lesion

  • Perio pocket does not extend up to the PA lesion
  • Tooth not vital

Tx: endo AND perio therapy

Prognosis of endodontic component is excellent but most be done with periodontal treatment otherwise limited healing of attachment apparatus

26
Q

What is primary periodontal lesion with secondary endodontic involvement? Symptoms?

A
  • Periodontal involvement extends to apex of tooth and causes retroinfection of pulp
    • Possibility of severe pain
27
Q

2 causes of primary periodontal lesion with secondary endodontic involvement?

A

infection of pulp from lateral canal exposure due to periodontal pocket

Dental abrasions from debridement causes exposure of tubules which may contribute to pulp death

28
Q

primary periodontal lesion with secondary endodontic involvement

Perio status?

Vitality?

Tx?

Prognosis?

A

Pt will have generalised periodontitis

Vitality will be mixed depending on severity - may be sensitive to cold

Tx: perio therapy in conjunction with RCT

Prognosis depends on perio therapy → favourable endodontic prognosis will only be obtained when tooth is in a closed/protected environment. Thus the PA lesion healing response is unpredictable

29
Q

What is a True Combined Lesion?

A

Lesion that forms when separate pulpal and periodontal pathoses develop independently and unite

30
Q

True combined lesion

Perio status

Vitality

Features

Radiographic appearance

A

significant periodontal involvement

Non vital

Tooth will have deep perio probing depths at multiple sites

radiograph to be taken with multiple gutta percha points in sulcus tracing them to apex

31
Q

Treatment of True Combined Lesion (3)

A

RCT

Perio therapy (initiated before, during or immediately after endo tx)

Possibly hemi-section or Root resection

32
Q

Prognosis of True Combined Lesion?

A

dependent on the perio therapy

  • the greater the periodontal involvement, the poorer the prognosis
33
Q
A
34
Q

How long after endo treatment (EPL) should you review tooth for and decide if you need graft?

A

6 months

Pic is of primary endo lesion that healed with endo tx only

35
Q

what are three alternative treatment modalities if EPL treatment is unsuccessful?

(ex. file fracture)

A

Root amputation in maxillary molars

Hemi section for mandibular molars

Extraction

36
Q

What treatment should be done first in EPL

A

ENDO

  • Must decide if tooth has good restorability first → otherwise extract

DS4102 (37 decks)

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