Endo - Perio Lesions
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DEFINITION
STOCK
Lesion with sub marginal or intra bony peri radicular bone loss of pulpal and/or periodontal origin that communicates with the oral cavity via probing defect.
An isolated, usually narrow, deep probing depth of pulpal or periodontal origin.
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Classification
COHEN
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Primary endodontic lesion
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Primary endodontic lesion with secondary periodontal involvement
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Primary periodontal lesion
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Primary periodontal lesion with secondary endodontic involvement
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True combined lesion
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Concomitant pulpal & periodontal lesion
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WEINE
Type I - Tooth in which symptoms clinically and radiographically simulate
periodontal
disease but are due to pulpal inflammation
Type II - Tooth that has both pulpal and periodontal disease concomitantly
Type III - Tooth has no pulpal problem but require endodontic therapy plus root amputation to gain periodontal healing
Type IV - Tooth that clinically and radiographically simulate pulpal or periapical disease but in fact have periodontal disease
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GROSSMAN GROUP 1- LESIONS REQUIRING ENDODONTIC TREATMENT ONLY
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Necrotic pulp and apical granulomatous tissue replacing periodontium with or without sinus tract
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Chronic peri apical abscess with sinus tract
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Longitudinal and horizontal root fractures
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Pathologic and iatrogenic root perforations
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Teeth with incomplete apical root development
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Endodontic implants
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Teeth that require hemi section
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Root submergence www.indiandentalacademy.com
GROUP 2 - LESIONS REQUIRING PERIODONTAL TREATMENT ONLY
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Occlusal trauma causing reversible pulpitis
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Occlusal trauma plus gingival inflammation resulting in pocket formation and reversible pulpitis
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Supra bony or infra bony pocket formation treated with overzealous root planning and curettage leading to pulpal sensitivity
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Extensive infra bony pocket formation extending beyond the root apex and sometimes coupled with lateral or apical resorption yet with pulp that responds with in normal limits to clinical testing
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GROUP 3 - LESIONS REQUIRING COMBINED ENDO-PERIO TREATMENT
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Any lesion in Group I That results in irreversible reactions in the attachment apparatus and requires periodontal treatment
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Any lesion in Group II that results in irreversible reactions to the pulp tissue and also requires endodontic treatment
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ATYPICAL ANATOMIC FACTORS Malaligned tooth Multirooted teeth / additional root Additional canal Cervical enamel projection Large lateral / accessory canal TRAUMA
With gingival inflammation Tooth fracture Pulp / perio involvement + sinus tract Cellular changes - resorption www.indiandentalacademy.com
MISCELLANEOUS Iatrogenic systemic
SINUS TRACT
INFRABONY POCKET
•From canal
•From gingival crevice
•Narrow
•wide
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Causes :( Stock )
Root canal infection
Root fractures – crown / root ( vital / non vital )
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Root perforation
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