Flashcards in Perio Endo Infection Deck (16)
Where does the pulpal and periodontium originate from?
Once the tooth has developed, how does the pulp and periodontium remain in contact?
Remain in contact through the apical foramina, accessory canals and exposed dentinal tubules and developmental grooves.
In addition to the above pathways, how else can pulpal infection affect the periodontium and vice versa?
In addition to said pathways, iatrogenic perforations/damage (RSD), resorption and root fracture also provide an egress for pulpal infection to affect the periodontium and vice versa.
Both pulpal and periodontal diseases have their terminal effects in the periodontal tissues. What differences are there in the initial manifestation in periapical disease and in periodontal disease?
The difference is that the initial manifestation in periapical disease is at the apex of the root whereas, in periodontal disease, it is at the cervical aspect of the tooth.
In pulpal and periodontal diseases, what occurs to the periodontal tissues and what kind of bacteria is dominant?
In both cases, the periodontal tissues become chronically inflamed as a result of an anaerobically and gram-negative dominated microbiota or on the adjacent root surface.
What is a periodontal-endodontic lesion?
Relatively small and unique group of clinical cases in which the origin of the disease process cannot be clearly discriminated are loosely termed perio-endo lesions.
They are an isolated, usually narrow, deep probing depth of pulpal or periodontal origin, in an otherwise disease-free mouth.
Lesion with sub-marginal or intra-bony periradicular bone loss of pulpal and/or periodontal origin that communicates with the oral cavity via a periodontal probing defect.
Lesions with higher chance of primary periodontal aetiology exhibit what 3 features that can cause perio-endo lesions?
- Generalised periodontal disease
- Poor oral hygiene and presence of calculus
- Periodontal probing defects that are generally broad rather than narrow
Lesions with primary endodontic aetiology generally exhibit what three features that cause perio-endo lesions?
- Absence of generalised periodontal disease
- Adequate oral hygiene
- Narrow, deep, isolated periodontal probing defect
What are the 5 classifications that Simon et al created to classify perio-endo lesions?
1. Primary endo lesions
2. Primary perio lesions
3. Primary endo/secondary perio lesions
4. Primary perio/secondary endo lesions
5. True combined lesions
Describe the radiographs and the diagnosis for A, 1, 2 and 3
A: Initial presentation radiograph revealed an apico-cervical bony defect along the distal aspect of tooth 45. The diagnosis was pulp necrosis with chronic apical abscess, complicated by primary endo/secondary perio pathoses.
1. Loss of periodontal supporting tissue noticed at baseline on the distal aspect of tooth 36.
2. Periapical radiograph revealed progression of periodontal attachment loss. Apico-cervical radiolucency was noted around the distal root. Furcation bone loss evident. Sclerotic change of lamina dura at apex of the mesial root and along the distal aspect of this root noticed.
3. Significant and rapid progression of the primary perio lesion into a true combined lesion
What is the treatment for primary endodontic lesion?
Root canal treatment
What is the treatment for primary endo/secondary perio lesion?
Root canal treatment and basic periodontal therapy
What is the treatment for primary perio/secondary endo lesion?
Supportive periodontal therapy, then root canal treatment, wait 3 months. If no change, advanced periodontal therapy, then extraction/root amputation/ hemisection.
What is the treatment for a true combined lesion?
Supportive periodontal therapy, root canal treatment, wait 3 months. If no change, advanced periodontal therapy, then extraction/root amputation/ hemisection
What is the treatment for primary periodontal lesion?