Further Complications - (Endo-Perio) Flashcards
(31 cards)
REGULARLY: ANY combination of multiple challenges to a tooth will
- _____ the Difficulty *
- _______ the Prognosis *
- ______ the Outcome of TX *
Increase
Reduce
Limit
- _____ involvement is almost always the LIMITING FACTOR in endo treatment/ perio treatment
PERIO
Now you need Endo Pulpal & Periapical Dx but ALSO a Periodontal Dx
and some idea of the Periodontal Prognosis _____ you begin any Tx.
BEFORE
What is the #1 pathway where perio and endo Interchange that occurs?
Apical foramen #1 (Natural or Procedural)
\_\_\_\_\_\_ are significant because they allow pulpal disease to extend directly to periodontal tissues.
Lateral canals
What is the most common pathway for endo to turn into perio and vice versa?
Apical foramen
Irritants from plaque that reach periodontal
tissues around lateral/accessory canals may
initiate inflammation in pulp followed by
______
necrosis.
Lateral canals may be ___um + wide; bugs are @
.5-1um
50
How often are lateral/furcation canals present in mand molars that can cause perio issues in necrotic pulps?
3/4 of time
– _______ is a natural protective barrier of the periodontium to pulp
Cementum
_____% may have a VOID @ CEJ)
18-25
T/F: You are NEVER dealing with PULP or
PERIODONTIUM alone. Both must be a
CONSIDERATION in ALL TREATMENT
True
We know that most properly selected endo will have \_\_\_\_ percentage success (largely regardless of the cooperation of the patient)
90+
What is the success rate of perio treatment determined by?
Patient compliance with TX
Pulpal injury initiates forthcoming LEO. Extension
of the pulpal inflammation procedes to the canals,
out the apex and irritates the periodontium (P/A
tissues) creating periodontal disease and loss of
bone.
A Drainage Tract originating from the apex or a lateral
canal may form along the root surface and exit via the
gingival sulcus. This is NOT a true perio pocket. Also is
NOT a classic Draining Sinus Tract (DST) but it serves the
same purpose of draining the lesion (via the Sulcus)
13
CLUES: Clinical Pulpal DX indicates Necrotic Pulp
Often a Rapid Onset + evidence of pulpal damage (caries, trauma, etc.)
In molar teeth, the furcation area may appear to have significant bone loss.
Minimal to no calculus & no evidence of generalized or advanced periodontitis
Tooth mobile or exhibits a narrow channel sinus tract (perhaps via sulcus)
Swelling present in the attached gingiva and tooth sore to biting or chewing.
With this Dx:
RCT ONLY is indicated.
Sinus tract & furca should heal w/o Tx following RCT
Do not curette furcation region or use caustic, inflammatory medications in the pulp chamber.
Pure Endo Lesion
When this Dx is determined: Both RCT & Periodontal Tx are indicated. Simultaneous management of endo and perio is preferable. If pulp is necrotic, RCT is 1st, then perio. Prognosis for resolution is dependent upon ability to treat BOTH entities successfully CLUES: Clinical Pulpal Dx indicates Necrotic Pulp Evidence for the presence of periodontal disease with vertical bone loss, Inflamed soft tissue and little or no calculus Radiographic changes in the pulpal space visible with linear or isolated calcific changes Look for some unusual deep pockets Little or no calculus in pockets No generalized perio condition
Primary Endo secondary perio
Clinical & radiographic assessments indicate
generalized, moderate to deep bony pockets
(cone shaped and wide) Calculus present
Diffuse inflammation
Asymptomatic patient & pulp responds to
sensibility testing WNL
When this Dx is
determined:TX is limited
to Periodontal Therapy
ONLY with the
prognosis dependent
upon the ability to
remove the causative
factors and the patient’s
ability to achieve
meticulous self-care
practices.
CLUES: Clinical Pulpal Dx indicates Normal Pulp (VITAL)
No deep caries nor other significant pulpal injury
Evidence for the presence of periodontal disease with vertical bone loss,
Inflamed soft tissue and calculus present.
Perio Only
Successful TX is RCT
1st followed by and
dependent upon the
ability to remove the
causative factors for
both periodontal
disease and the
patient’s ability to
achieve meticulous self-
care practices once the
RCT has been
successfully performed.
CLUES: Clinical Pulpal Dx indicates SIP or Necrotic Pulp
Tooth often may have or needs extensive restoration
Evidence for the presence of periodontal disease with vertical bone loss,
Inflamed soft tissue and calculus present.
Clinical & radiographic assessments indicate broad-
based probings, vertical & possible apical or lateral
bone loss.
Infection from the deep perio pocket invades the
pulpal tissue via the apical foramen & causes pulpitis
Symptoms acute & history of previous extensive
perio TX
Perio - Endo: (Primary Perio lesion with
2ndary Endo Involvement)
Perform RCT first to
manage acute symptoms
(if any). Treat periodontal
concomitantly. Successful
TX is dependent upon the
ability to remove all
causative factors for
periodontal disease and
the patient’s ability to
achieve meticulous self-
care practices once the
RCT has been performed.
CLUES: Clinical Pulpal Dx indicates Necrotic Pulp
Tooth often has or needs extensive restoration or has suffered trauma
Evidence for the presence of periodontal disease with vertical bone loss,
Inflamed soft tissue and calculus present.
Clinical & radiographic assessments indicate broad
based probings & intraboney perio pocket
Communication with an isolated peri-radicular lesion
of pulpal origin (same as 4. but both lesions develop
at the same time)
Symptoms may be acute or chronic (if present – due
to pulpal inflammation)
Probing may reveal vertical fracture (generally TE)
“True” Combined Lesion: (RARE Combined or Concomitant Perio
& Endo involvement)
\_\_\_\_\_\_\_ is one of the best means to differentiate endodontic from periodontal pathosis.
Pulp sensibility
testing
\_\_\_\_ impact on \_\_\_\_\_\_ • Process Rapid & Acute • Pulpal symptoms often present • Radiographic appearance of extension to the periodontium usually an Isolated Finding • Pocket narrow, drop-off, no calculus • Process Chronic • Pulp undergoes Slow Degeneration • Pulpal symptoms usually absent • Generalized periodontal disease usually present • Pockets Wide base,Cone- shaped, usually calculus
Pulpal Inflammation
impact on Periodontium
\_\_\_\_\_\_ impact on \_\_\_\_\_\_ Process Chronic • Pulp undergoes Slow Degeneration • Pulpal symptoms usually absent • Generalized periodontal disease usually present • Pockets Wide base,Cone- shaped, usually calculus present
Periodontal Inflammation
impact on the Pulp
INTERNAL RESORPTION is
routinely and successfully treated
with _____
RCT (if NOT perforating)
Are there any Txs that give predictable outcomes for ERR?
No
