endo note 13 perioendolesion

1

Perio Endo Lesions

8/31/2009 Endo 13

2

Medical historySenbility testingPocket depthFurcation involvementTooth mobilityRadiograph

8/31/2009 Endo 13

3

Non vital carious toothLateral canalFurcation involvementLocal Periodontal abscessLocalized deep pocketGood periodontal conditionResolution after RCT

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4

Drain through the periodontiam Buccul abscess

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5

Drain through the furcation

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6

Non vital toothLateral canalFurcation involvementLocal Periodontal abscessLocalized deep pocketpoor periodontal conditionResolution after RCT + perio Rx

8/31/2009 Endo 13

7

Deep periodontal pocket

8/31/2009

Periodontal probe 6mm

Endo 13

8

Nonvital second premolar

8/31/2009

Lateral canal

Endo 13

98/31/2009 Endo 13

Generalized poor periodontal conditionGeneralized deep pocketGeneralized Periodontal abscessDevelopmental defectsLateral canalFurcation involvementSound vital or nonvital toothResolution after perio Rx + RCT

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Food accumulation deep pocket & vitaltooth Calculi & root concavity

8/31/2009 Endo 13 11

Generalized poor periodontal conditionGeneralized deep pocketGeneralized Periodontal abscessPrevious perio RxDevelopmental defectsLateral canalFurcation involvementSound non vital toothResolution after perio Rx and RCT

8/31/2009 Endo 13 12

Palato-gingival groove ofmaxillary lateralliincisor

Cervical enamel projectionon mandibular molar

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Generalized poor periodontal conditionGeneralized deep pocketGeneralized Periodontal abscessCarious non vital toothTwo lesions coalesceResolution depend on perio Rx and RCTand amount of bone loss

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Generalized poor periodontal conditionGeneralized deep pocketGeneralized Periodontal abscessCarious non vital toothResolution depend on perio Rx and RCTand amount of bone loss

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Clinical

Origin of infection

Vitality

Restorative

Plaque / calculus

Inflammation

Pockets

PH value

Trauma

Microbial

Treatment

8/31/2009

Pulpal

Pulpal

Nonvital

Deep or extensive

Not related

Acute

Single and narrow

Often acid

Iry or IIry

Few

Root canal therapy

Endo 13

Periodontal

Periodontal

Vital

Not related

Primary cause

Chronic

Wide, coronally and multiple

Usually alkaline

Contributing factor

complex

Periodontal treatment

20

Radiological

Pattern

Bone loss

Periapical

Vertical bone loss

Treatment

8/31/2009

Pulpal

Localized

Wider apically

Radiolucent

No

Root canal therapy

Endo 13

Periodontal

Generalized

Wider coronally

Not often related

Yes

Periodontal treatment

21

Histopathology

Junctional epithelium

Granulation tissue

Gingival

Treatment

8/31/2009

Pulpal

No apical migration

Apical minimum

Normal

Root canal therapy

Endo 13

Periodontal

Apical migration

Coronal larger

Some recession

Periodontal treatment

22

Traditional endodontic & periodontic RxResection (extraction or root amputation)Implant or fixed prosthesisRestoring (bone replacement graft usingguided tissue and bone regenerationtechniques)

8/31/2009 Endo 13 23

Root fractureRoot perforationRoot cariesDehiscenceFenestrationin multy rooted tooth

External root resorptionImpaired root canal treatmentsevere periodontitisFurcation involvement

8/31/2009 Endo 13 24

Deep pocket and calcifiedmesial root

Five years after rootamputation

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Fractured toothExtensive decayed toothExternal root resorptionInternal root resorptionLateral perforation

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Fractured toothExtensive decayed toothExternal root resorptionInternal root resorptionLateral perforation

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Less than 1cmReduced enamel epitheliumRemnant of dental laminaCell rest of MalassezFifth to seventh decayed of lifeMale predominantMandibular posterior regionUnicystic or multicystic

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Discharging sinus After flap reflection

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After enucleation After three month

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Before two years After forming lesion

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After one year post operativelyRadiologic ally clinically

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Reflected buccul flap Osseous window

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Repaired defect with freeze dried bone allograft and coveredwith a collagen membrane

Before surgery

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At the time of surgery After 6 month

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After two years Before surgery

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PretreatmentReflected full thickness muco-periosteal flap 7 mm pocket

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Oseouss defect filled withcancellous bovine bone (BioOss)

Collagen membranes(Ossix) over the BioOss

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Preoperative One year after treatment

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Preoperative One year after treatment

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