Endodontic periodontic lesion Flashcards

1
Q

How does infec from the PDL to the pulp occur?

A

Pathogenic bac and inflam products of perio disease access canal/lateral walls/apical foramen = pulpal infec/necrosis (retrograde pulpitis)

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2
Q

How does infec from the pulp to the PDL occur?

A

Pulpal disease
Procedural errors in RCT
Perforations
Vertical root fractures

= dentinal tubules, peri-radicular inflam

= bone loss and CAL +/- Pus discharge = retrograde periodontitis

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3
Q

Endo-perio lesion classification?

A

Primary endodontic 2ndry periodontal lesion

OR primary periodontal 2ndry endodontic lesion

Both cause true - combined periodontal-endodontic lesions

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4
Q

Primary endo secondary perio lesion?

A

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

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5
Q

Primary perio 2ndry endo lesions?

A

Perio pocket can deepen to the apex and secondarily involve the pulp
Alternatively a perio pocket can infec the pup through a lateral canal

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6
Q

True combined lesion?

A

2 independent lesions (periapical and periodontal) can coexist and eventually fuse with each other

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7
Q

What classifications have been suggested to find the source of the infection?

A

Concurrent endodontic and periodontal disease without communication

Concurrent endodontic and periodontal disease with communication

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8
Q

Why is knowing if lesions are communicating useful?

A

Non-communicating lesions suggest a true combined lesion with independent aetiology

Communicating lesions may be true combined lesions which have merged or lesions starting primarily as perio or endo and then spread to the other

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9
Q

Why is knowing the original source of infection important?

A

It can implicate the management and prognosis of the case

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10
Q

How to form a diagnosis?

A

History
Exam - endodontic, periodontal
Special tests - sensibility testing, radiographs

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11
Q

What are the common clinical symptoms?

A
Mobility
Gingival swelling
Pus discharge
Pocket formation
Fistula tract
TTP
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12
Q

What is involved in the endodontic exam?

A

Restorative status
TTP
Tenderness in sulcus
Swelling/sinus

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13
Q

What is involved in the periodontal exam?

A

Probing around tooth )6 point)
Pus discharge from pocket
Mobility

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14
Q

What are the special tests? Results for a perio-endo lesion?

A

Ethyl chloride
EPT
Tooth should be negative to both = non-vital

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15
Q

What radiographs should be taken? Results for a perio-endo lesion?

A

PA = most appropriate
Vertical periodontal defect is often present
Radiolucency around the apex is present
A J shaped lesion may be present

OPT only indicates multiple sites needed for radiographs

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

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16
Q

What other tests can be performed?

A

Tooth sleuth
Transillumination
= Rules out root fracture

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17
Q

How to manage primary endo 2ndry perio lesion?

A

RCT
Review after 3 months
If no improvements in pocketing = non-surgical perio therapy
No improvement after another 3 months = surgery

18
Q

How to manage primary perio 2ndry endo?

A

RCT and perio therapy
Review after 3 months
If no improvements = surgical perio therapy

19
Q

How to manage true combined lesions?

A

RCT and perio therapy
3 month review - no improvement = further non-surgical perio therapy
3 months - no improvement - surgical perio

20
Q

Rationale for management of primary endo 2ndry perio lesion?

A

Primary endo 2ndry perio lesions have endodontic aetiology
Endo infec drains into the PDL
Perio lesion usually presents as a narrow defect
Endo tx usually resolves issue as it removes the infec source
Perio defect is often very narrow and not really conductive to instrumentation

21
Q

Rationale for management of primary perio 2ndry endo lesion?

A

Have a periodontal aetiology but the tooth has become non-vital = RCT
= Endo and perio therapy required

22
Q

Rationale for management of true combined lesions?

A

Have endo and perio aetiology
May or may not communicate
Endo and perio therapy indicated

23
Q

Alternative management options?

A

Place Calcium Hydroxide inside prepared canal rather than obturating whilst assessing the response to the perio therapy
Obturation is only undertaken once a response to the perio therapy is seen
HOWEVER no evidence to suggest this is better

Surgical intervention may be indicated earlier e.g. with v deep pockets, not conductive to non-surgical perio therapy

Molar teeth = if one root is more affected than the other = root resection or hemisection

Often, root resection undertaken on the mesio-buccal or disto-buccal roots of upper molar teeth and hemisection is undertaken on lower molars

24
Q

Prognosis of each perio-endo lesion?

A

Primary endo 2ndry perio = generally good prognosis

Primary perio 2ndry endo and true combined lesions = prognosis depends on extent of perio bone loss

25
Q

Lesions masquerading as perio-endo lesions?

A

Developmental grooves
Perforations
Root fracture
Resorption

26
Q

What can developmental grooves do?

A

Can predispose to formation of a deep perio pocket = if untreated can cause pulp death (primary perio 2ndry endo lesion)

27
Q

How to manage developmental grooves?

A

Endo tx and perio therapy but surgery may be required due to the groove

28
Q

Where can perforations occur?

A

Can occur during endo or during placement of an endodontic post or dentine pin

29
Q

How may the perforation clinically present?

A

Deep pocket leading to the site of perforation

May not be radiographically obvious as it’s a 2D image

30
Q

What can perforations lead to?

A

Bone loss around the site of the periodontium

31
Q

How to manage perforations?

A

Assessment of the restorability of the tooth
If unrestorable = extraction
Restorable = repair of the perforation either internally or externally using MTA or biodentine = biocompatible materials

Best performed by endodontist

32
Q

What may present in a similar way to perio-endo lesions? How?

A

Root fracture with a narrow, deep, isolated perio pocket

J shapes lesion may be present radiographically

33
Q

How to manage root fracture?

A

Assessing the extent of the fracture

Any vertical fracture extending onto the root face will require extraction

34
Q

What types of root resorption are relevant to perio-endo lesions?

A

External root resorption

  • External cervical resorption
  • External replacement resorption

Internal root resorption

35
Q

Features of external cervical root resorption?

A

Unknown aetiology
May be associated with previous trauma
Resorption usually starts subgingivally in the cervical region
Pulp is usually vital and only becomes involved when the lesion has progressed extensively
Often asymp
May be mistaken for perio endo lesion as pocketing may present
The resorption lesion fills with gingival tissue so the pocketing is rarely deep

36
Q

How to assess and treat external cervical root resorption?

A

CBCT may be useful to assess the extent of the lesion
Tx involves surgical exploration of the lesion followed by repair
Endo tx may or may not be required
= Specialist tx and referral should be instigated as soon as diagnosis is suspected

37
Q

External replacement resorption?

A

Root surface is gradually replaced with bone = ankylosis
Often has traumatic origin
Can be transient and self limiting but will often progress until complete root replacement occurs
Clinically when the lesion has progressed significantly a catch may be present at the gingival margin = can mimic a perio-endo lesion

38
Q

What does external replacement resorption diagnosis base on?

Clinical features?

A

Radiological appearance and clinical exam = high-pitched, metallic sound on percussion
May be non-mobile tooth and may become infra-occluded in children still growing

39
Q

How to treat the external replacement resorption?

A

No tx to stop the ankylosing process

40
Q

Internal root resorption features?

A

Occurs entirely in the canal system
Results in an ovoid expansion of the root canal
Outline of the canal will be lost around the area of resorption
Pulp will likely be chronically inflamed
Pink spot lesion may be visible through enamel if occurs in coronal aspect of tooth
Tooth is usually partially vital and there may be symptoms of pulpitis

41
Q

What occurs if internal root resorption continues to expand?

A

Eventually may perforate through the root = periodontal lesion may develop

42
Q

How to treat internal root resorption?

A

Endo tx
Obturation can be difficult due to unusual canal anatomy
Thermal obturation techniques (involving backfill with molten GP) is required