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Endo / Perio Connection Flashcards

1
Q

4 major endo- perio connection

A
  1. lateral canals
  2. dentinal tubules
  3. apical foramina
  4. iatrogenic perforation
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2
Q

lateral canals?

A

while migrating apically and forming the rooth the epithelial sheath of hertwig

  • can have discontinuties
  • run across blood vessels

these disruptions lead to the formation of lateral canals

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3
Q

most frequent area of lateral canals?

A

APICAL THIRD

- do not forget they are in the FURCATIONS OF MOLARS

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4
Q

describe dentinal tubules

A

number and size

  • decrease from pulp to cementum
  • decrease from cervical to apical
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5
Q

dentinal fluid - basic

A

content of the dentinal tubules

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6
Q

pressure within the dentinal fluid

A

approx. 14 cm H20 - 10.3 mmHg

some pressure directed outwards

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7
Q

features of dentinal fluid

A

protective and transport media

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8
Q

brannstrom’s hydrodynamic theory

A

the rapid movement of dentinal fluid in the dentinal tubules stimulates the A-delta nerve fibers located in the odontblastic layer of the pulp

  • mechano-stimualtion
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9
Q

significance with the apical foramen

A

most significant pathway of communication between pulp and periodontium

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10
Q

periodontal aspects of clinical exam imoortance

A

PD (probing depth)

bleeding on probing

purulence

mobility

density of marginal bone

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11
Q

SOAP format

A

S - subjective findings

O - Objective Findigns

A - Assessment (diagnostic pulpal-peri-radicular)

P - Pain of treatment

  • endo
  • perio
  • prosth
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12
Q

what compromises subjective findings

A
  1. chief complaint

2. history of present condition

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13
Q

what compromises objective findings

A
  1. clinical exam
  2. radiogrpahic exam
    diagnostic tests
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14
Q

heat test have to keep for longer?

A

yes - because C fibers are slower to respond

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15
Q

tracing the sinus tract importance?

A

NEED TO SEE WHERE IT ENDS – so maybe a vertical radiograph will be beneficial

is there maxillary sinus involvement?

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16
Q

accuracy of CBCT is in determining vertical root fractures?

A

HELPFUL

- 86% vs 66% (when using a PA)

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17
Q

which slices in CBCT are most accurate?

A

AXIAL slices

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18
Q

average sensitivity of CBCT for vertical root fracture

A

50%

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19
Q

dentin infection how?

A
  1. death of odontoblast
  2. dead tract
  3. bacterial infiltration
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20
Q

pulpal response to carious lesion

A
  1. pulpal inflammation
  2. local tissue destruction
  3. formation of microabscesses
    - attempt to wall off infection
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21
Q

frequently overlooked findings radiographically

A
  1. sinus tract
  2. resorptive defect
  3. perforation
  4. bone rarefraction pattern /
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22
Q 
clinical diagnosis (3) 
these are NOT WHAT
A
  1. cracked tooth
  2. VRF
  3. endo-perio lesion

*these are NOT describing pulpal or perio diagnose

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23
Q

is there an effect of periodontal inflammation on the pulp?

- general

A

yes and no
- research defending both sides

likely in extreme conditions

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24
Q

classification on endo-perio lesions

Simon 1972

A
  1. primary endodontic lesion with secondary periodontal involvement
  2. primary periodontic lesion with secondary endodontic involvment
  3. true combined endo-perio lesion
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25
primary perio with 2nd endo
can reach apex and then effect the pulp | - irreversible pulpitis stage or necrotic
26
combined?
endodontic disease - bacteria wants to go out and at same time - perio lesion from crest of bone down and they meet
27
endodontic drainage?
path of least resistance?
28
endodontic drainage?
path of least resistance? | - so case dependent
29
spread of odontogenic infection
anatomic position of tooth in relation to buccal and lingual cortical plates \\relationship of apex of tooth to closest muscle attachment
30
main features of primary endo secondary perio
1. pulp necrosis 2. good oral hygeine 3. no perio disease 4. intrasulcular drainage - tunnel/ narrow probing - furcation involvment 5. non angular crestal bone loss
31
main features of primary perio secondary endo
1. chronic disease 2. angular bone loss -- slow destruction of attachment apparatus 3. pain is low intensity to hard to localize 4. tooth may be vital 5. corono-apical direction 6. produces wide probing 7. looser gingival margina 8. pulp will survive unless foramen area is compromised
32
common ways endo -peerio lesions | although they are uncommon they are associated with endo-perio lesions
1. enamel pearl - usually in molar furcation areas 2. cemental tear - piece of radio-opacity 3. palatal groove - on upper anterior teeth
33
importance of probing?
narrow or wide? | narrow -- endo more likely
34
VRF hard to diagnose?
yes - because they mimic endo-perio lesions
35
severity of periodontal disease correlate with pulpal necrosis?
some studies show both (yes and no) - pulp can affect the periodontium - there is more epithelium around infected teeth - there is more connective tissue around non-infective teeth so before perio procedure need to makesure you have a healthy pulp situation
36
Tx. strategies and clinical outcome depends on?
- extent of perio disease - assessment of therapeutic prognosis, with the intended regenerative procedure - tooth mobility - properly performed root canal treatment - appropriate healing time NEED GOOD PERIO PROGNOSIS - then do endo and then wait 2/3 months for healing
37
steps to examine a tooth with a crack
1. perio probing 2. radiographic examination 3. restoration removal 4. staining 5. transilluminaiton 6. wedging forces 7. surgical assessment
38
classification of cracked teeth
1. craze lines 2. fracture cusp? 3. cracked tooth 4. split tooth 5. vertical root fracture (VRF) *goes in order of not as 'big of a problem to more'
39
craze lines usually present as? where?
on posterior teeth - marginal ridges extend B and or L anterior teeth - long vertical clinical - enamel (limited to here usually), no symptoms, esthetic concerns depending on how light hits it?
40
diagnose craze lines?
transillumination | - DD = fractured cusp
41
transillumination differentitates?
Light is still PASSING THROUGH CRAZE LINE - IF CROSSES OVER -- MEANS CRACK IS NOT DEEP -- SO NOT A CRACK -- CRAZE LINE IN CRACK LIGHT STOPS AT FX LINE - does not cross over line
42
fractured cusp
complete or incomplete - cna look like a craze line - surrounds a cusp M-D and B-L - above or below CEJ - LIGHT STOPS AT FX LINE
43
craze lines limited to?
enamel | - if crosses into dentin - it is a crack
44
bite test
cusp specific - pressure on specific cusp on the tooth to break down bite test into the different points on the same tooth flexure?? - will be pain and pulp reation NOT USEFUL ON PREVIOUSLY TREATED - no pulpal response
45
fractured cusp treatemtn
- assess pulp vitality - remove effected pulp - assess restorability - restore cusp or full cuspal protection +/- RCT (seldom needed if just a fracture in the cusp) - if pulp involvement obviuoustl treat this - if not move onto the restorative component
46
fractuer cusp different from cracked tooth?
YES
47
cracked tooth starts where?
STARTS AT CROWN LEVEL | - called greenstick fracture / incomplete fracture
48
cracked tooth usually extends?
M-D : marginal ridges (centered) | - if apically (+/- pulpal involvement)
49
diagnostic clues for cracked tooth
PAIN ON RELEASE - place instrument in crack - use wedging test
50
no movement?
cracked tooth
51
piece breaks off with wedge test
fractured cusp
52
crown and root movement with wedge test
split tooth
53
cracked tooth tx. planning? guided by?
guided by endo diagnosis - pulp and periapical) and perio diagnosis - endo tx if needed exaplin prognosis and different options
54
tx considerations with cracked tooth
chasing the crack line in a vital tooth
55
prognosis of cracked tooth
based on clinical findings and clinical judgement share findings with pt. and discuss if left unprotected -- can naturally lead to a split tooth clinical research studies are limited
56
prognosis of split tooth
poor | - probably needs extraction
57
split tooth
complete fracture crown down to apical area M-D direction tooth segments are seprate - wedge test
58
VRF characteristics
initiated at the ROOT at any level - usually extend towards the occlusal surface/ chewing surface - usually are found when surrounding bone and gum become infected B-L direction complete or indirect
59
VRF diagnostic clues
- minimal - mimics endo- perio lesions - almost always associated with RCT - narrow deep or rectangular pattern probing
60
VRF pathognomonic signs
sinus tract AND narrow isolated probing AND previous RCT - independent of presence of post - may be presence of amalgam in canal orrifice
61
VRF tx
extraction hemisection or root amputation when indicated
62
VRF prevention
avoid excessive removal of tooth structure avoid wedging forces especially if lateral condensation is used avoid post placement unless needed for crown retention
63
VRF prevention
avoid excessive removal of tooth structure avoid wedging forces especially if lateral condensation is used avoid post placement unless needed for crown retention
64
crack goes M-D what type?
crack tooth | not syndrome
65
prognosis if crack is identified early enough?
dont jump to endo | - crown can be protective to a certain extent
66
Ng. et all 2011 importance? conditions found to improve tooth survival?
conditions to improve tooth survival: - patency of canal is acheived - absnence of root filling extrusion - teeth with cast restoration after tx - teeth with adjacent teeth present - no cast and pore for support
67
fracture necrosis associated with?
pulp necrosis in the absence of restorations, caries, or luxations injuries, is likely caused by a longitudinal fracture extending from occlusal surface into the pulp extractions may be considered tx of choice
68
cemental tear?
basically necrotic cementum with microorganisms | -piece of cementum that detaches from the root
69
how involvement of a palato-ginginval groove can present
- no cavitities or restoration - poor oral hygeine - negative pulp test positive percussion PD WNL except a drop of 10mm on PL + pus mobility WNL
70
TX of palato-gingival groove
prophy NSRCT - scaling and root planning open flap depridement in apex area treat surface bone graft and collagen membrane CHX use follow up
71
direction of crack for cracked tooth vs VRF
VRF- from B-L cracked tooth - from M-D

Endotontics (21 decks)

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