Questions and Answers
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?
27-59%
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?
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What can cause Endo-Perio lesions?
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What is an Endodontic Infection?
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What is a Periodontal Infection?
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What are Combined Lesions?
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What are the characteristics of Periodontal disease?
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What differentiates an Endodontic condition?
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What factors contribute to trauma and iatrogenic issues?
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What is the microbiology of Endo-Perio lesions?
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What are the risk factors for Endo-Perio lesions?
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What are the guidelines for Endo-Perio classification?
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What is an Endo-Perio lesion with root damage?
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What characterizes an Endo-Perio lesion without root damage?
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What is involved in the diagnostics for Endo-Perio lesions?
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What does prognosis depend on for Endo-Perio lesions?
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How can periodontal pocketing mimic a periapical radiolucency?
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What are the steps in treatment guidance for Endo-Perio lesions?
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What defines concurrent endodontic and periodontal diseases without communication?
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What effects can periodontal treatment have on pulp health?
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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.
