EndoPerio

Question 1

Clinical Presentation for Endo/Perio
Lesions
(4)

Answer 1

• Clinical scenarios involving both pulp and
  periodontium
• Acute
• Chronic
• If related to recent traumatic or iatrogenic event,
  may manifest as PAIN with an Abscess

Question 2

Signs and Symptoms
(2)

Answer 2

• Deep periodontal pockets (approaching apex)
• Altered or negative response to pulp vitality
  (sensibility) tests

Question 3

Signs and Symptoms
(6)

Answer 3

• Bone resorption in apical or furcation region
• Spontaneous pain or pain on palpation/percussion
• Exudate
• Tooth mobility
• Sinus tract
• Crown and gingival color changes

Question 4

Etiology

Answer 4

• Microbial contamination of the pulp and
  periodontium
  A. Related to periodontal &/or endodontic infection
  B. Related to trauma/Iatrogenic factors

Question 5

Perio/Endo infection
(3)

Answer 5

• Primary Endodontic
• Primary Periodontic
• True ‘Combined’ lesion

Question 6

• Primary Endodontic

Answer 6

• caries affecting pulp and subsequent periodontal
  involvement

Question 7

• Primary Periodontic

Answer 7

• periodontal destruction that then affects the pulp

Question 8

Associated with Trauma/Iatrogenic
Factors
(3)

Answer 8

• Root damage
• External root resorption (due to trauma)
• Necrotic pulp (from trauma then draining through
  periodontium)

Question 9

• Root damage
  (2)

Answer 9

• Perforation of root, pulp chamber or furcation (during
  preparation for root canal or post)
• Root fracture or crack (iatrogenic or trauma)

Question 10

Bacterial Profile
(2)

Answer 10

• Generally, there is not a specific microbial profile
  for the EPL
• No major difference between lesion of endodontic
  origin vs. periodontal origin

Question 11

Risk Factors (affect prognosis)
(3)

Answer 11

• Advanced periodontal disease
• Trauma and iatrogenic events
• Anatomic factors

Question 12

• Anatomic factors
  (3)

Answer 12

• Root grooves**
• Furcation involvement
• PFM crowns and active carious lesions

Question 13

So why the change?
Original diagnostic classification for EPL was
(5)

Answer 13

• Primary endo
• Primary endo secondary perio
• Primary perio
• Primary perio secondary endo
• True combined lesion

Question 14

However, determining primary source is not relevant for treatment as

Answer 14

both root canal and periodontal tissues require treatment

Question 15

Diagnosis
Base treatment options on presenting disease status
* Determine prognosis
(3)

Answer 15

• Hopeless (usually due to trauma/iatrogenic
  factors and leads to extraction)
• Poor
• Favorable

Question 16

Diagnosis
(3)

Answer 16

1. Determine history (if known) of root damage
2. Obtain radiographs and clinical examination
3. Determine root anatomy and integrity

Question 17

1. Determine history (if known) of root damage

Answer 17

• trauma, root canal treatment, post preparation

Question 18

2. Obtain radiographs and clinical examination

Answer 18

• probing depths, perforation, fracture, root resorption

Question 19

No evidence of root damage
Perform full periodontal assessment
(6)

Answer 19

• Probing depths
• Attachment levels
• Bleeding/suppuration
• Mobility
• Percussion
• Vitality testing

Question 20

Assessment
(for 2017 classification)
Need to determine if tooth in question has
(2)

Answer 20

a) Root damage (and if so, what type?)
b) No root damage

Question 21

b) No root damage
(2)

Answer 21

a) Periodontitis patient ?
b) Non periodontitis patient ?

Question 22

Endo-Periodontal lesion with root damage
(3)

Answer 22

Root fracture or crack
Root canal or pulp chamber perforation
External root resorption

Question 23

Perio-Endo
* Difficulty in
* Difficulty in
* Difficulty in

Answer 23

Diagnosis
Treatment
Determining Prognosis

Question 24

Physical Routes of
Communication
(4)

Answer 24

• Apical Foramen
• Lateral (Accessory) Canals
• Dentinal Tubules (Controversial)
• Iatrogenic

Question 25

* Lateral (Accessory) Canals * Kirkham (75) found --% and Rubach (65) found --% on single-rooted teeth * Gutman (78) found --% in molar furcations**

Answer 25

28 45 28

Question 26

Physical Routes of Communication  Dentinal Tubules  Seltzer (67) found --% incidence of inflammation in pulp and periodontium  Adriaens (88) demonstrated --- in dentinal tubules (false positives in controls may indicate contamination)

Answer 26

21 bacteria

Question 27

Healing Potential  Osseous lesions of endodontic origin can be expected to ---  Osseous lesions of periodontic origin are usually ---  The greater the periodontic involvement, the --- the prognosis

Answer 27

heal completely not reversible and depend on defect morphology for regeneration worse

Question 28

Differential Diagnosis (4)

Answer 28

 Incomplete Tooth Fracture  Developmental Grooves  Cervical Enamel Projections  Periodontal Abscess

Question 29

Incomplete Tooth Fracture (4)

Answer 29

 Radiographic isolated vertical bone loss  “Teardrop” radiolucency  Can mimic both periodontal and endodontic symptoms  May be seen as an incomplete crown, root, or tooth fracture

Question 30

Developmental Grooves (3)

Answer 30

 Gingival palatal groove incidence of 4-8% on maxillary incisors  Localized osseous lesion  “Peri-pulpal” line on radiograph

Question 31

Cervical Enamel Projections (2)

Answer 31

 Various extent of CEPs from grade I to grade III (which extend into furcation)  Incidence from 17-32% (much higher incidence in Asian populations)

Question 32

Periodontal Abscess (3)

Answer 32

 Symptoms consistent with periodontal abscess  Radiograph is indicative of periodontal disease  Acute abscess has better prognosis than chronic abscess

Question 33

Treatment Considerations  --- evaluation is needed with endodontic evaluation to determine prognosis and treatment options  --- usually is done first  --- follows endo  (2) may be viable alternative

Answer 33

Periodontal Endodontics Periodontal therapy Root resection or hemisection