p.3
Diagnosis of Periodontitis
What are the signs and symptoms of periodontitis?
Attachment loss and deep pockets, bleeding, tooth mobility, plaque & calculus deposits, positive to cold/pulp tests, radiographic bone loss, generally painless.
p.8
Impact of Pulp Infections on Periodontium
Can periodontal infections affect the pulp?
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.
p.32
Prognosis and Treatment Options for Combined Lesions
What is the prognosis for combined periodontic and endodontic disease without communication?
The prognosis is better without communication.
p.37
Prognosis and Treatment Options for Combined Lesions
What factors influence the prognosis of combined periodontal and endodontic lesions?
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.
p.14
Diagnosis Techniques for Combined Lesions
What role do radiographs play in the diagnosis of dental diseases?
Radiographs are essential for visualizing the internal structures of teeth and surrounding tissues, helping to identify issues such as decay, fractures, and periodontal disease.
p.42
Management Steps for Endo-Perio Disease
What is the significance of DB root resection in Endo-Perio cases?
DB root resection can help manage combined periodontal and endodontic diseases by removing infected root structures, thereby improving the prognosis of the tooth.
p.16
Differentiation between Endodontic and Periodontal Diseases
What is a probing defect in an endodontic lesion?
A probing defect in an endodontic lesion is narrow and long, often referred to as a narrow sinus tract.
p.43
Differentiation between Endodontic and Periodontal Diseases
Why is it important to establish a correct diagnosis in endodontic and periodontal diseases?
A correct diagnosis determines the extent, type, and sequence of treatment required, as well as assigning a reliable prognosis.
p.16
Differentiation between Endodontic and Periodontal Diseases
What can a probing defect in an endodontic lesion mimic?
It can mimic a periodontal defect due to the way it drains.
p.19
Diagnosis of Periodontitis
What is the age and ethnicity of the patient in the case report?
17 year old male, Black African from Eritrea.
p.4
Signs and Symptoms of Pulpal Disease
What are the signs and symptoms of reversible pulpitis?
Sensitivity to cold or hot that doesn’t linger long.
p.32
Prognosis and Treatment Options for Combined Lesions
How does communication affect the prognosis of combined periodontic and endodontic disease?
Combined with communication has worse prognosis.
p.24
Differentiation between Endodontic and Periodontal Diseases
What are incomplete coronal fractures in dentistry?
Incomplete coronal fractures, also known as cracked tooth syndrome, are fractures that extend into the root of a tooth.
p.13
Diagnosis Techniques for Combined Lesions
What are the two recommended tests for assessing pulp sensitivity?
The two recommended tests for assessing pulp sensitivity are cold (using CO2) and electric pulp testing (EPT).
p.17
Differentiation between Endodontic and Periodontal Diseases
How does extensive caries affect the diagnosis of periodontal and pulpal disease?
Extensive caries can be a sign of both endodontic and combined disease.
p.27
Classification of Combined Periodontic and Endodontic Disease
What defines primary periodontal disease in the context of combined lesions?
Primary periodontal disease is defined by the presence of periodontal pockets and attachment loss that may subsequently affect the pulp.
p.15
Differentiation between Endodontic and Periodontal Diseases
What is the significance of radiographic interpretation in endodontics?
Radiographic interpretation in endodontics is significant for identifying periapical lesions, assessing root canal anatomy, and determining the success of previous treatments.
p.39
Management Steps for Endo-Perio Disease
What was the sample size in Cortellini 2011 study regarding hopeless teeth?
The sample size was 50 hopeless teeth.
p.31
Classification of Combined Periodontic and Endodontic Disease
What are the two classifications of combined periodontic and endodontic diseases?
Concurrent endodontic and periodontal diseases without communication and concurrent endodontic and periodontal diseases with communication.
p.10
Differentiation between Endodontic and Periodontal Diseases
Why is diagnosing combined endo-perio disease considered tricky?
Diagnosis of combined lesions can sometimes be tricky due to the overlapping signs and symptoms of both endodontic and periodontal diseases.
p.29
Prognosis and Treatment Options for Combined Lesions
What should be considered when determining if treatment is worth pursuing?
Alternative options must be discussed, along with cost and time considerations.
p.12
Prognosis and Treatment Options for Combined Lesions
What treatment options are available for Endo-Perio lesions?
Treatment options may include endodontic therapy, periodontal therapy, or a combination of both, depending on the severity and nature of the lesions.
p.30
Classification of Combined Periodontic and Endodontic Disease
What defines primary periodontal disease in the context of combined lesions?
Primary periodontal disease is defined by the presence of periodontal pockets and attachment loss, which may subsequently affect the pulp.
p.35
Management Steps for Endo-Perio Disease
What are the management steps for a concurrent periodontal and endodontic lesion?
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.
p.33
Prognosis and Treatment Options for Combined Lesions
What factors influence the prognosis of combined periodontal and endodontic disease?
The extent of periodontal involvement and the cause of pulpal disease.
p.24
Differentiation between Endodontic and Periodontal Diseases
What is a crown-root fracture?
A crown-root fracture is a type of fracture that involves both the crown and the root of a tooth.
p.12
Differentiation between Endodontic and Periodontal Diseases
How should the diagnosis of Endo-Perio lesions be approached?
Diagnosis should involve differentiating between endodontic and periodontal components, using clinical signs and symptoms, and appropriate diagnostic tests.
p.39
Combined Periodontic-Endodontic Disease
What type of lesions were involved in the Cortellini 2011 study?
Perio-endo lesions and/or attachment loss to the apex.
p.33
Management Steps for Endo-Perio Disease
What is the first step in combined periodontal and endodontic therapy?
Treat the acute condition first.
p.5
Impact of Pulp Infections on Periodontium
Can pulp infections affect the periodontium?
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.
p.17
Differentiation between Endodontic and Periodontal Diseases
What are the differential diagnosis signs for endodontic disease?
Extensive caries/restoration, pulp sensitivity tests, percussion, and palpation.
p.24
Differentiation between Endodontic and Periodontal Diseases
What is root resorption?
Root resorption is a condition where the body breaks down and absorbs the tissue of the tooth root.
p.15
Diagnosis Techniques for Combined Lesions
What types of radiographs are commonly used in dental examinations?
Common types of radiographs used in dental examinations include periapical, bitewing, and panoramic radiographs.
p.34
Management Steps for Endo-Perio Disease
What is the first step in managing concurrent Endodontic-Periodontal disease?
Treat the acute condition.
p.39
Management Steps for Endo-Perio Disease
What was the control treatment in the Cortellini 2011 study?
Extraction and replacement with conventional or implant-supported fixed prosthesis.
p.18
Impact of Pulp Infections on Periodontium
What is a transient pulpal response?
A transient pulpal response refers to a temporary reaction of the dental pulp to stimuli, which may occur during or after periodontal treatment.
p.2
Differentiation between Endodontic and Periodontal Diseases
What is the aim of the lecture regarding endodontic and periodontal diseases?
To understand the presentation of endodontic, periodontal, and combined diseases, and how to differentiate between them.
p.2
Impact of Pulp Infections on Periodontium
What are some distinct conditions that may have endo and perio implications?
Root perforations, fractures, cracks, caries, root resorption, orthodontic complications, and developmental anomalies.
p.30
Classification of Combined Periodontic and Endodontic Disease
What are the main categories in the classification of combined periodontic and endodontic disease?
The main categories include primary endodontic disease with secondary periodontal involvement, primary periodontal disease with secondary endodontic involvement, and true combined lesions.
p.27
Classification of Combined Periodontic and Endodontic Disease
What is a true combined lesion in the classification of combined periodontic and endodontic disease?
A true combined lesion is characterized by simultaneous involvement of both the periodontal and endodontic tissues, often requiring a comprehensive treatment approach.
p.34
Management Steps for Endo-Perio Disease
What is the next step after starting endodontic treatment in concurrent EP disease management?
Clean canals and medicate with ledermix or a 50:50 mixture of ledermix and Ca(OH)2.
p.4
Impact of Pulp Infections on Periodontium
How can inflammation from pulp disease affect the periodontal ligament?
It can extend to the periodontal ligament, causing tenderness to pressure, biting, or tapping.
p.13
Diagnosis Techniques for Combined Lesions
Why are pulp tests not always reliable in diagnosing combined endo-periodontic disease?
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.
p.16
Differentiation between Endodontic and Periodontal Diseases
How does a probing defect in an endodontic lesion typically present?
It usually presents as a narrow sinus tract, indicating that the endodontic lesion is draining through the bone rather than the periodontal ligament.
p.27
Classification of Combined Periodontic and Endodontic Disease
How is primary endodontic disease characterized in the classification?
Primary endodontic disease is characterized by pulp necrosis and periapical lesions that may lead to periodontal tissue involvement.
p.24
Differentiation between Endodontic and Periodontal Diseases
What are palatal grooves?
Palatal grooves are anatomical features that can predispose teeth to caries and periodontal issues.
p.15
Diagnosis of Periodontitis
How does a radiographic exam assist in diagnosing periodontal disease?
A radiographic exam assists in diagnosing periodontal disease by revealing bone loss, the presence of calculus, and the condition of the periodontal ligaments.
p.9
Combined Periodontic-Endodontic Disease
How can advanced periodontitis affect the pulp?
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.
p.4
Signs and Symptoms of Pulpal Disease
What characterizes irreversible pulpitis?
Severe pain, lasting throbbing, and altered response to pulp tests.
p.11
Differentiation between Endodontic and Periodontal Diseases
What indicates that a lesion may be of endodontic origin in combined periodontic-endodontic disease?
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.
p.26
Classification of Combined Periodontic and Endodontic Disease
What is a major problem with the previous classification of Endo-Perio lesions?
It is confusing because we don't really know what the primary source of infection is.
p.40
Prognosis and Treatment Options for Combined Lesions
What conclusion did Cortellini reach in 2011 regarding regenerative therapy?
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.
p.29
Prognosis and Treatment Options for Combined Lesions
What factors contribute to the decision-making process in dental treatment?
Cost and time are significant factors, often rated as +++.
p.35
Management Steps for Endo-Perio Disease
How long is the management period for concurrent periodontal and endodontic lesions?
The management period can vary, but it is often recommended to monitor and treat these lesions over a span of 6 months.
p.10
Diagnosis Techniques for Combined Lesions
What are the important clinical examination tools for diagnosing combined endo-perio disease?
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.
p.17
Differentiation between Endodontic and Periodontal Diseases
What signs indicate periodontal disease?
Probing defect (wide), crestal bone loss, and positive percussion and palpation.
p.37
Prognosis and Treatment Options for Combined Lesions
Why can periodontal prognosis be difficult to determine initially?
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.
p.13
Diagnosis Techniques for Combined Lesions
How can partial necrosis of a pulp affect pulp testing results in multi-rooted teeth?
In multi-rooted teeth, partial necrosis of a pulp may allow for a positive response to pulp testing, complicating the diagnosis.
p.43
Combined Periodontic-Endodontic Disease
What factors influence the success of treating combined endodontic and periodontal diseases?
The success usually depends on the periodontal healing; getting a periodontal opinion early can help avoid expense and time loss.
p.41
Management Steps for Endo-Perio Disease
What are some treatment options for combined periodontic-endodontic disease?
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.
p.26
Classification of Combined Periodontic and Endodontic Disease
What uncertainty exists regarding the lesions in Endo-Perio classification?
It is unclear whether the lesions are communicating or separate.
p.43
Management Steps for Endo-Perio Disease
What should be done if the root canal system is infected concurrently with a periodontal infection?
Endodontic treatment should be commenced at least 4 weeks prior to any periodontal therapy.
p.12
Management Steps for Endo-Perio Disease
What role does patient education play in managing Endo-Perio lesions?
Patient education is crucial for understanding the importance of oral hygiene and compliance with treatment plans to ensure successful outcomes.
p.30
Classification of Combined Periodontic and Endodontic Disease
What is a true combined lesion in the classification of combined periodontic and endodontic disease?
A true combined lesion is characterized by simultaneous involvement of both the periodontal and endodontic tissues, often requiring a comprehensive treatment approach.
p.33
Management Steps for Endo-Perio Disease
Why is it better to start with endodontic treatment in combined lesions?
Infected root canals hinder periodontal healing.
p.4
Impact of Pulp Infections on Periodontium
What are the consequences of untreated pulp disease?
Pulp necrosis and eventual infection, leading to bone resorption and radiolucency around the apex, in furcation, or lateral to the root.
p.29
Prognosis and Treatment Options for Combined Lesions
What are the categories of prognosis in dental treatment?
Hopeless, Poor, Favourable.
p.24
Differentiation between Endodontic and Periodontal Diseases
What is a vertical root fracture?
A vertical root fracture is a fracture that runs vertically along the root of a tooth.
p.15
Diagnosis Techniques for Combined Lesions
What is the purpose of a radiographic exam in dentistry?
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.
p.2
Classification of Combined Periodontic and Endodontic Disease
What classifications are discussed in the lecture?
Both old and new classifications of endodontic and periodontal diseases.
p.34
Management Steps for Endo-Perio Disease
How long should you wait before starting periodontal treatment after initiating endodontic treatment?
Wait a minimum of 4 weeks.
p.11
Differentiation between Endodontic and Periodontal Diseases
Why is it easier to determine the origin of a lesion in combined periodontic-endodontic disease when a vital pulp test is obtained?
A positive result from a vital pulp test will rule out an endodontic origin, except in multi-rooted teeth with partial necrosis of pulp.
p.17
Combined Periodontic-Endodontic Disease
What are the signs of combined periodontal and endodontic disease?
Wide probing defect, crestal bone loss, and positive responses to percussion and palpation.
p.12
Management Steps for Endo-Perio Disease
What are the initial steps in the management of Endo-Perio lesions?
The initial steps include a thorough clinical examination, radiographic assessment, and determining the extent of the lesions.
p.2
Diagnosis Techniques for Combined Lesions
Why is achieving the correct diagnosis important in endodontic and periodontal diseases?
It is crucial for understanding prognosis and management of the presenting condition.
p.30
Classification of Combined Periodontic and Endodontic Disease
How is primary endodontic disease characterized in the classification?
Primary endodontic disease is characterized by pulp necrosis and periapical lesions that may lead to periodontal tissue involvement.
p.35
Combined Periodontic-Endodontic Disease
What is a concurrent periodontal and endodontic lesion?
A concurrent periodontal and endodontic lesion is a condition where both periodontal and endodontic diseases occur simultaneously, often leading to complex management challenges.
p.34
Management Steps for Endo-Perio Disease
When should complete endodontic treatment be performed in the management of concurrent EP disease?
Complete endo when the prognosis is established.
p.33
Management Steps for Endo-Perio Disease
What is the management approach for concurrent periodontal and endodontic lesions without communication?
Management should be conducted over a period of 3 years.
p.27
Classification of Combined Periodontic and Endodontic Disease
What are the main categories in the classification of combined periodontic and endodontic disease?
The main categories include primary endodontic disease with secondary periodontal involvement, primary periodontal disease with secondary endodontic involvement, and true combined lesions.
p.26
Classification of Combined Periodontic and Endodontic Disease
What is lacking in the previous classification of Endo-Perio lesions?
There is no guidance on prognosis or treatment.
p.34
Management Steps for Endo-Perio Disease
What should be done with restoration or caries during the management of concurrent EP disease?
Remove restoration/caries and assess if it is restorable.
p.34
Management Steps for Endo-Perio Disease
What must an interim restoration be during the management of concurrent EP disease?
The interim restoration must be cleansable.
