ortho and endo
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1
benefits of ortho for perio pts
correct crowding: align malposed teeth > facilitate access for plaque removal
uprighting: align, reduce/correct tissue defects, improve occlusion
correction of pathologic migration: extrusion, labial flaring, rotation
intrusion: correction of tissue defects, favorable crown:root ratio
uprighting: align, reduce/correct tissue defects, improve occlusion
correction of pathologic migration: extrusion, labial flaring, rotation
intrusion: correction of tissue defects, favorable crown:root ratio
2
how does a missing tooth contribute to bad perio
occlusal forces no longer directed down the tooth > supraeruption
food impaction in the IPC of supraerupted tooth
food impaction in the IPC of supraerupted tooth
3
how to fix missing tooth perio
selective coronoplasty > prevent additional destruction of supporting tissue
likely need fixed prosth
likely need fixed prosth
4
what is pathologic migration assoc w
PERIODONTITIS AND OCCLUSAL TRAUMA MAIN!
MAYBE loss of posterior tooth support
MAYBE loss of posterior tooth support
5
what does perio therapy need to do before ortho
remove deposits and resolve marginal inflammation
6
types of perio endo lesions
primary endo: endo infection from PA or accessory foramen into periodontium
primary perio: perio pocket deepens to apex, 2ndary pulp involvement
primary perio 2ndary endo: perio pocket infect pulp via acc. canal > PA lesion
true combine lesion: two indep lesions, PA and perio, coexist and eventually fuse
primary perio: perio pocket deepens to apex, 2ndary pulp involvement
primary perio 2ndary endo: perio pocket infect pulp via acc. canal > PA lesion
true combine lesion: two indep lesions, PA and perio, coexist and eventually fuse
7
tx for combined perio-endo lesion
endo therapy first
removal plaque/calculus, non surg or surgical
evaluate tooth for residual pocket or bony defect
periodontal therapy (osseous resective surgery, regeneration)
removal plaque/calculus, non surg or surgical
evaluate tooth for residual pocket or bony defect
periodontal therapy (osseous resective surgery, regeneration)
8
how to tell apart perio lesion
might have pain but if no pain its perio
swelling within gingiva
VITAL PULP!
swelling within gingiva
VITAL PULP!
9
how to tell apart endo lesion
NO POCKETS
NEGATIVE VITAL PULP TEST
RL at apex
NEGATIVE VITAL PULP TEST
RL at apex
10
how to tell apart perio-endo
swelling around root
no vitality in pulp
RL anywhere along root
no vitality in pulp
RL anywhere along root
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