Endo-perio lesion

Attachment loss and deep pockets, bleeding, tooth mobility, plaque & calculus deposits, positive to cold/pulp tests, radiographic bone loss, generally painless.

The effect of periodontal disease on the pulp is not as clear-cut. Normal pulps are observed in the majority of teeth with advanced periodontal disease, but a small percentage of teeth can cause pulp infections if the apical foramina is invaded.

The prognosis is better without communication.

The prognosis depends on the cause of disease, amount of remaining tooth structure, attachment loss, mobility, root anatomy, furcation, healing response, oral hygiene, compliance with supportive periodontal therapy, restoration longevity, and the skill of the clinician.

A regenerative strategy.

Radiographs are essential for visualizing the internal structures of teeth and surrounding tissues, helping to identify issues such as decay, fractures, and periodontal disease.

DB root resection can help manage combined periodontal and endodontic diseases by removing infected root structures, thereby improving the prognosis of the tooth.

A probing defect in an endodontic lesion is narrow and long, often referred to as a narrow sinus tract.

A correct diagnosis determines the extent, type, and sequence of treatment required, as well as assigning a reliable prognosis.

It can mimic a periodontal defect due to the way it drains.

17 year old male, Black African from Eritrea.

Sensitivity to cold or hot that doesn’t linger long.

Combined with communication has worse prognosis.

Incomplete coronal fractures, also known as cracked tooth syndrome, are fractures that extend into the root of a tooth.

The two recommended tests for assessing pulp sensitivity are cold (using CO2) and electric pulp testing (EPT).

Extensive caries can be a sign of both endodontic and combined disease.

Primary periodontal disease is defined by the presence of periodontal pockets and attachment loss that may subsequently affect the pulp.

Radiographic interpretation in endodontics is significant for identifying periapical lesions, assessing root canal anatomy, and determining the success of previous treatments.

The sample size was 50 hopeless teeth.

Concurrent endodontic and periodontal diseases without communication and concurrent endodontic and periodontal diseases with communication.

Diagnosis of combined lesions can sometimes be tricky due to the overlapping signs and symptoms of both endodontic and periodontal diseases.

Alternative options must be discussed, along with cost and time considerations.

Treatment options may include endodontic therapy, periodontal therapy, or a combination of both, depending on the severity and nature of the lesions.

Primary periodontal disease is defined by the presence of periodontal pockets and attachment loss, which may subsequently affect the pulp.

Management typically involves a combination of endodontic treatment to address the pulp condition and periodontal therapy to manage the periodontal aspect, often requiring a multidisciplinary approach.

The extent of periodontal involvement and the cause of pulpal disease.

A crown-root fracture is a type of fracture that involves both the crown and the root of a tooth.

Diagnosis should involve differentiating between endodontic and periodontal components, using clinical signs and symptoms, and appropriate diagnostic tests.

Perio-endo lesions and/or attachment loss to the apex.

Treat the acute condition first.

Yes, pulpal disease can cause periodontal changes. Infections in the pulp can spread through lateral canals and accessory canals into the periodontal ligament, potentially leading to bone destruction. This can also occur via cracks and dentinal tubules.

Extensive caries/restoration, pulp sensitivity tests, percussion, and palpation.

16% - 17%

Root resorption is a condition where the body breaks down and absorbs the tissue of the tooth root.

Common types of radiographs used in dental examinations include periapical, bitewing, and panoramic radiographs.

Treat the acute condition.

Extraction and replacement with conventional or implant-supported fixed prosthesis.

A transient pulpal response refers to a temporary reaction of the dental pulp to stimuli, which may occur during or after periodontal treatment.

To understand the presentation of endodontic, periodontal, and combined diseases, and how to differentiate between them.

Root perforations, fractures, cracks, caries, root resorption, orthodontic complications, and developmental anomalies.

The main categories include primary endodontic disease with secondary periodontal involvement, primary periodontal disease with secondary endodontic involvement, and true combined lesions.

A true combined lesion is characterized by simultaneous involvement of both the periodontal and endodontic tissues, often requiring a comprehensive treatment approach.

Clean canals and medicate with ledermix or a 50:50 mixture of ledermix and Ca(OH)2.

It can extend to the periodontal ligament, causing tenderness to pressure, biting, or tapping.

Pulp tests may not always provide accurate results, especially in multi-rooted teeth where partial necrosis can lead to a positive response despite underlying issues.

It usually presents as a narrow sinus tract, indicating that the endodontic lesion is draining through the bone rather than the periodontal ligament.

Primary endodontic disease is characterized by pulp necrosis and periapical lesions that may lead to periodontal tissue involvement.

Palatal grooves are anatomical features that can predispose teeth to caries and periodontal issues.

A radiographic exam assists in diagnosing periodontal disease by revealing bone loss, the presence of calculus, and the condition of the periodontal ligaments.

Advanced periodontitis can allow bacteria to gain access to the pulp via accessory canals or the apex of the root, leading to infection of the pulp.

Severe pain, lasting throbbing, and altered response to pulp tests.

If the pulp is non-responsive and the infection can be traced to a lateral canal or apical foramen, the lesion is suspected to be of endodontic origin.

It is confusing because we don't really know what the primary source of infection is.

Regenerative therapy can change the prognosis of a tooth from 'hopeless' to fair or favorable and is a suitable alternative to extraction of severely compromised teeth.

Cost and time are significant factors, often rated as +++.

The management period can vary, but it is often recommended to monitor and treat these lesions over a span of 6 months.

Wait 3 months.

The important clinical examination tools include pulp sensibility test, periodontal probing/full chart, suppuration, mobility, radiographs (PAs, CBCT), a good history (trauma, procedures, symptoms), visual appearance of soft tissues, caries, restorations, anatomical factors, and transillumination.

Probing defect (wide), crestal bone loss, and positive percussion and palpation.

Periodontal prognosis can be difficult to determine initially due to the complexity of factors involved, including the cause of disease and the condition of the tooth structure.

In multi-rooted teeth, partial necrosis of a pulp may allow for a positive response to pulp testing, complicating the diagnosis.

The success usually depends on the periodontal healing; getting a periodontal opinion early can help avoid expense and time loss.

The ortho department.

Root resections, hemisections or premolarization (with or without root removal), extraction without replacement or using the crown as a pontic, and fixed or resin retained bridges, dentures, or implants if appropriate.

It is unclear whether the lesions are communicating or separate.

Endodontic treatment should be commenced at least 4 weeks prior to any periodontal therapy.

Patient education is crucial for understanding the importance of oral hygiene and compliance with treatment plans to ensure successful outcomes.

A true combined lesion is characterized by simultaneous involvement of both the periodontal and endodontic tissues, often requiring a comprehensive treatment approach.

Infected root canals hinder periodontal healing.

Pulp necrosis and eventual infection, leading to bone resorption and radiolucency around the apex, in furcation, or lateral to the root.

Hopeless, Poor, Favourable.

A vertical root fracture is a fracture that runs vertically along the root of a tooth.

The purpose of a radiographic exam in dentistry is to visualize the internal structures of teeth and surrounding tissues, aiding in the diagnosis of dental diseases.

Both old and new classifications of endodontic and periodontal diseases.

Wait a minimum of 4 weeks.

5 years follow-up.

A positive result from a vital pulp test will rule out an endodontic origin, except in multi-rooted teeth with partial necrosis of pulp.

92% - 100%

Wide probing defect, crestal bone loss, and positive responses to percussion and palpation.

The initial steps include a thorough clinical examination, radiographic assessment, and determining the extent of the lesions.

It is crucial for understanding prognosis and management of the presenting condition.

Primary endodontic disease is characterized by pulp necrosis and periapical lesions that may lead to periodontal tissue involvement.

A concurrent periodontal and endodontic lesion is a condition where both periodontal and endodontic diseases occur simultaneously, often leading to complex management challenges.

Clear medical history.

Complete endo when the prognosis is established.

Management should be conducted over a period of 3 years.

The main categories include primary endodontic disease with secondary periodontal involvement, primary periodontal disease with secondary endodontic involvement, and true combined lesions.

There is no guidance on prognosis or treatment.

Remove restoration/caries and assess if it is restorable.

The interim restoration must be cleansable.