Perio-Endo Lesions

Perio-Endo Lesions

1. Apical periodontitis

   • Presentation
     • Pain on biting + TTP
     • Apical radiolucency
     • Carious / restored tooth
     • Non-vital pulp
   • Apical abscess
     • Acute
       • Swelling assoc. with tooth
       • Facial swelling
       • Pain - worse on biting + TTP
     • Chronic
       • If sinus - apical to mucogingival junction
   • Cause
     • Caries
       • Infected pulp
         • Peri-radicular inflammation

2. Marginal periodontitis

   • Presentation
     • More likely generalised (affects multiple teeth)
     • No pain
     • Gingival inflammation or recession
     • Bleeding
     • Horizontal or vertical bone loss from margin
     • Deep PDs
       • Wide
     • Calculus
   • Cause
     • Plaque accumulation
       • Gingival inflammation
         • Inflammation spreads to PDL & bone
           • Migration of JE + bone loss
   • Periodontal abscess
     • Suppuration from pocket
     • If sinus - coronal to mucogingival junction
     • Pain - worse on biting + TTP

3. = Apical periodontitis + Marginal periodontitis

   • Non-communicating
     • Origin
       • Marginal periodontitis
       • Apical periodontitis
         • Caries -> Infected pulp
     • Treatment = RCT + RSI
     • Radiograph
       • Separate lesions
         • Marginal bone loss
         • Apical radiolucency
   • Comunicating
     • Origins
       • Marginal periodontitis + Apical periodontitis
         • Previously non-communicating lesions that have grown & are now connected
       • Marginal periodontitis
         • Spread to apex -> Apical periodontitis
           • Can infect pulp as bacteria/toxins can enter canal through apex
       • Apical peridontitis
         • Spread to marginal periodontium
         • More likely with lateral canal infections/perforations
     • Radiograph
       • Radiolucency from margin to apex
     • Treatment
       • Most likely = XLA
       • RCT then RSI
       • Hemi-section
         • If only 1 root in multi-rooted tooth affected