Perio-endo lesion

Question 1

What are signs and symptoms of perio endo lesions

Answer 1

o Deep periodontal pockets reaching or close to the apex
o Negative or altered response to pulp vitality tests
o Bone resorption in the apical or furcation region
o Spontaneous pain
o Pain on palpation and percussion
o Purulent exudate
o Tooth mobility
o Sinus tract
o Crown and gingival colour alterations

Question 2

What are causes of perio endo lesions

Answer 2

o Necrotic pulp that is draining through the apex of the tooth into the PDL rather than discharging buccally, could also be a lateral canal which is draining higher up
o Necrotic pulp but draining through the furcal canals – may see furcal pathology
o Severe periodontal disease which will have impact on the pulp via exposed dentinal tubules/lateral canals - dentine is exposed at CEJ in around 18% of teeth, more common on anterior teeth
o Perforation
o Developmental groove

Question 3

Classification of perio endo lesions

Answer 3

Question 4

Tx of perio endo lesions

Answer 4

o Carry out endodontic treatment of the affected tooth
o Recommend optimal analgesia
o Do not prescribe AB unless signs of spreading infection or systemic involvement
o Recommend 0.2% CHX until acute symptoms subside
o Following acute management of the lesion, review within ten days and carry out supra and subgingival PMPR if necessary and arrange an appropriate recall interval