Podcast
Questions and Answers
What is an Endo-Perio Lesion?
What is an Endo-Perio Lesion?
Pathologic communication between pulp and periodontal tissues
What is the prevalence of accessory canals primarily in the furcation of multirooted teeth?
What is the prevalence of accessory canals primarily in the furcation of multirooted teeth?
27-59%
What is the clinical presentation of an Endo-Perio lesion?
What is the clinical presentation of an Endo-Perio lesion?
Abscess accompanied by pain; in periodontitis, can have slow and chronic progression without evident symptoms.
What are the signs and symptoms of Endo-Perio lesions?
What are the signs and symptoms of Endo-Perio lesions?
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What can cause Endo-Perio lesions?
What can cause Endo-Perio lesions?
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What is an Endodontic Infection?
What is an Endodontic Infection?
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What is a Periodontal Infection?
What is a Periodontal Infection?
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What are Combined Lesions?
What are Combined Lesions?
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What are the characteristics of Periodontal disease?
What are the characteristics of Periodontal disease?
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What differentiates an Endodontic condition?
What differentiates an Endodontic condition?
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What factors contribute to trauma and iatrogenic issues?
What factors contribute to trauma and iatrogenic issues?
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What is the microbiology of Endo-Perio lesions?
What is the microbiology of Endo-Perio lesions?
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What are the risk factors for Endo-Perio lesions?
What are the risk factors for Endo-Perio lesions?
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What are the guidelines for Endo-Perio classification?
What are the guidelines for Endo-Perio classification?
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What is an Endo-Perio lesion with root damage?
What is an Endo-Perio lesion with root damage?
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What characterizes an Endo-Perio lesion without root damage?
What characterizes an Endo-Perio lesion without root damage?
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What is involved in the diagnostics for Endo-Perio lesions?
What is involved in the diagnostics for Endo-Perio lesions?
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What does prognosis depend on for Endo-Perio lesions?
What does prognosis depend on for Endo-Perio lesions?
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How can periodontal pocketing mimic a periapical radiolucency?
How can periodontal pocketing mimic a periapical radiolucency?
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What are the steps in treatment guidance for Endo-Perio lesions?
What are the steps in treatment guidance for Endo-Perio lesions?
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What defines concurrent endodontic and periodontal diseases without communication?
What defines concurrent endodontic and periodontal diseases without communication?
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What effects can periodontal treatment have on pulp health?
What effects can periodontal treatment have on pulp health?
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What does case 1 emphasize regarding radiographic bone loss?
What does case 1 emphasize regarding radiographic bone loss?
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Study Notes
Endo-Perio Lesions Overview
- Pathologic communication exists between pulp and periodontal tissues known as Endo-Perio lesions.
- Prevalence of accessory canals in multirooted teeth ranges from 27% to 59%.
Clinical Presentation
- Abscess formation is often accompanied by pain.
- Periodontitis may present chronic progression without evident symptoms.
Signs and Symptoms
- Deep periodontal pockets, typically around 10mm, are common.
- Altered responses to pulp vitality tests indicate potential pulpal involvement.
- Bone resorption may occur in the apical or furcation regions.
- Symptoms include spontaneous pain, pain on palpation, and percussion.
- Presence of purulent exudate from periodontal pockets or gingival sulcus.
- Tooth mobility and formation of a sinus tract are indicators of severe lesions.
- Crown and gingiva may exhibit changes in color such as erythema and edema.
Aetiology
- Causes include endodontic or periodontal infections.
- Trauma and iatrogenic factors can exacerbate conditions.
Endodontic vs. Periodontal Infections
- Endodontic infections can cause pulp issues, with possible draining through the periodontal ligament into the gingival sulcus, resembling a periodontal abscess.
- Periodontal lesions involve wider true periodontal pockets that affect root canals but may maintain pulp vitality despite disease progression.
Combined Lesions
- Both periodontal and endodontic infections may coexist, either in patients with periodontitis or without.
Distinguishing Features
- Periodontal: Wider PDL coronally, evidenced radiographically by crestal bone loss; presents as moderate pain and swelling.
- Endodontic: Wider PDL at the apex without crestal bone involvement; typically severe pain with swelling localized to the apex.
Trauma and Iatrogenic Factors
- Injuries may lead to perforation, root fractures, external root resorption, or pulp necrosis.
- These factors contribute to a poorer treatment prognosis.
Microbiology
- No significant differences in microorganisms between endodontic and periodontal lesions; both are primarily anaerobic.
- Typical pathogens include P. gingivalis and T. forsythia from the "red" and "orange" complexes.
Risk Factors
- Severe periodontitis, active carious lesions, grooves, and trauma contribute to endo-perio lesion development.
- Iatrogenic factors and specific restorations, like porcelain-fused-to-metal crowns, increase risk.
Guidelines for Classification
- The 2017 World Workshop outlines two classifications based on root damage status:
- Lesions with root damage (e.g., fractures).
- Lesions without root damage categorized further based on periodontal pocket depth.
Diagnostic Considerations
- Comprehensive patient history assessment and evaluation for root integrity are necessary.
- Vitality testing, especially for multirooted teeth, aids in determining the impact of pulpal status.
- A full mouth periodontal assessment distinguishes between types of pockets.
Prognosis Influencing Factors
- Prognosis relies on root damage presence, pre-treatment attachment loss, response to healing, and dental treatment effectiveness.
Periodontal Pocketing Confusion
- Periodontal pockets can imitate periapical radiolucencies, requiring accurate testing to differentiate conditions.
Treatment Guidance
- Steps include identifying lesions, assessing root damage, examining vitality, and making decisions on RCT or periodontal treatment based on tooth vitality status.
Concurrent Endodontic and Periodontal Conditions
- Teeth may present with both apical periodontitis and separate periodontal pocketing without direct communication between the two conditions.
Effects of Periodontal Treatment
- Periodontal procedures may induce pulp inflammation, but significant damage to the pulp is rare unless the disease reaches the apex.
Case Consideration
- In cases of radiographic bone loss linked to endo-perio lesions, affected teeth are often excluded from primary periodontal diagnoses.
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Description
This quiz covers essential aspects of Endo-Perio lesions, focusing on the pathologic interactions between pulp and periodontal tissues. It includes clinical presentations, symptoms, and potential causes, helping dental professionals understand these complex conditions better.
