Week 8 Sharma- Endo-Perio Flashcards
What are the pathways of communication for endo perio lesions?
- Apical foramen
- Accessory canals
- Dentinal tubules (deficient cementum, excess root planing & debridement)
What are the 3 types of endo-perio lesions?
- Primary endo/secondary perio lesion (endo lesion can seep through apex or accessory canals and form perio lesion)
- Primary perio/secondary endo lesion (pulp becomes infected from deep perio pocket)
- True combined lesion (hard to tell what happens first- caries and pocket formation present)
What are anatomical predisposing factors for endo/perio lesions?
- Lingual grooves
- Root / tooth fractures
- Root anomalies
- Intermediate bifurcation ridges
- Cervical enamel projections
- Trauma-induced root resorption
What is the 2017 endo-perio lesions classifications (classification to use for diagnosis)?
- Endo-perio lesion with root damage (root fracture or cracking, perforation, ERR)
- Endo-perio lesion without root damage
- EPL in periodontitis pt (grade 1-3)
- EPL in non-periodontitis pt (grade 1-3)
What is hopeless EPL associated with?
Trauma or iatrogenic factors (perforation)
What is poor or favourable prognosis of EPL associated with?
EPL’s associated with endo and periodontal lesions and depends on extent of perio involvement
What are effects of pulpal diseases on periodontium?
- As long as pulp remains vital, significantly inflamed pulp exerts little or no effect on periodontium.
- Necrosis of pulp results in bone resorption and apical radiolucency in the furcation or along the root.
When is hemisection or root resection often carried out?
- Perforation
- Fractured file during endo
- Furcation involvement
- Extensive BL around one root
What are the 3 grades for E/P lesions in periodontitis and non-periodontitis patients?
- Grade 1: narrow deep perio pocket in 1 tooth surface
- Grade 2: wide deep perio pocket in 1 tooth surface
- Grade 3: deep perio pockets in >1 tooth surface
What are some endodontic procedures that can affect periodontium?
- Pulp extirpation
- Cleaning and shaping of root canal
- Debris pushed into PDL
- Extension of files, reamers or filling materials
- Perforation of floor of pulpal chamber
- Vertical root fracture during obturation or post placement
What are periodontal procedures affecting pulp?
- Deep curettage- can damage apical vessels
- Scaling and debridement can remove cementum leading to open dentinal tubules and possibly lateral canals
What are characteristics of primary endo lesion?
Necrotic pulp with chronic apical periodontitis & sinus tract draining through PDL or gingival sulcus
- Not a true endo-perio lesion
- Radiograph reveals isolated periodontal problems around an individual tooth
- Usually no associated generalised periodontal disease
What do investigations reveal for primary endo lesions
- Negative pulp vitality
- Tracing tract often reveals origin is at apex of tooth. May also go to mid root when lateral canal is involved
What is the treatment for primary endo lesion?
- Conventional RCT
- Sinus usually heals after RCT and no root debridement needed
What is prognosis for primary endo lesion?
- Excellent prognosis
- Radiographic and clinical healing is rapid
- Complete healing usually in 3-6 months
What are characteristics of primary perio lesion?
- Can sometimes mimic endo problem, clinically & radiographically
- Minimal or no pain in perio disease (dull pain)
- If painful, there may be coronal fracture that extends into PDL
- Perio pocket may reach apex of involved tooth
What are clinical test findings for primary perio lesions?
- Pulp testing of teeth are WNL
- Deep pocket present
What are treatments for primary perio lesions?
- Periodontal therapy
- RCT isn’t indicated unless pulp vitality changes
- Re-evaluation must be performed periodically after therapy to check for possible retrograde endo problems
What is the prognosis of primary perio lesions?
- Entirely dependent on perio therapy
- Most teeth with periodontitis resulting in AL to apex do NOT have favorable prognosis
What are primary endodontic lesions with primary periodontal involvement + clinical test results?
Primary endodontic lesion with an independent periodontal lesion
- Pulp vitality -ve
- Perio pockets present do not extend up to periapical lesion
What is tx for primary endo lesion with primary periodontal involvement?
- Good, conservative endo
- Perio debridement
What is prognosis of primary endo lesion with primary periodontal involvement?
- Endo component prognosis is excellent. Regeneration of attachment apparatus is limited by perio prognosis
- If RCT alone, limited healing is expected bc periodontal component of lesion is not treated adequately
What is primary perio lesion with secondary endodontic involvement?
- When periodontal involvement extends to apex of tooth, retroinfection of pulp tissue may occur.
- Pt sometimes has severe pain
- Infection of pulp can follow path through lateral canal
- Dentinal abrasions and root debridement can also contribute to death of pulp
What are results of clinical tests for primary perio lesions with secondary endo involvement?
- Pt often has generalized periodontitis
- Pulp vitality test results can sometimes be mixed
- When pulp is inflamed, application of cold produces an immediate response
What is tx for primary perio lesions with secondary endo involvement
- Conservative RCT
- Perio therapy should be initiated and can proceed in conjunction with the endo
What is prognosis of primary perio lesion with secondary endo involvement?
- Prognosis is dependent on perio therapy
- Healing response of periapical lesion is not predictable bc of perio communication
- Favourable endo prognosis is obtained only when tooth is in closed and protected environment
- Failures also occur when a perio problem develops in a tooth with anatomical issues like fused roots in posterior teeth
What are true combined lesions?
Lesion is formed with pulpal and perio pathosis develop independently and unite
- Usually have significant perio involvement
- Similar to secondary endo involvement on pre-existing primary perio lesions
What is differential diagnosis for true combined lesions?
Vertical root fracture
What are clinical test results for true combined lesions?
- Negative pulp test
- Tooth will have deep perio probing depths at multiple sites
- Radiographs by placing perio probe, multiple GP point or silver points into sulcus and tracing them to apex
What is tx for true combined lesion?
- Perio therapy can be initiated before, during or immediately after endo tx
- Number of advanced perio and endo clinical approaches may be required- hemi-section or root resection, apicoectomy.
What is prognosis for true combined lesions?
- Dependent on perio therapy
- Greater the perio involvement, poorer the prognosis
What are alternative treatment modalities when traditional endo and perio treatments are insufficient?
- Root amputation (mx molars w/ untreatable perio BL)
- Hemi-section (md molars)
