Endodontics
Course Review
Enoch Ng, DDS 2014
Lesion Classification
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Primary endo
o
Inflamed/necrotic pulp
o
Possible isolated perio defect
o
Osseous destruction localized to involved tooth
o
Healing via regeneration of perio and osseous structures
o
Endo treatment only
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Primary perio
o
Generalized bone loss
o
Local factors present
o
Healing usually via reattachment
o
Vital pulp
o
Perio treatment only
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Primary endo with secondary perio
o
Endo disease caused a perio communication
o
Endo treat first, evaluate after 2 months, perio treat if needed
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Primary perio with secondary endo
o
Perio disease, then necrotic pulp
o
Osseous destruction exposes dentinal tubules, accessory canals, apical foramen
o
Endo treat first, then perio treat 2 months later
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Concomitant endo-perio
o
Endo and perio disease exist separately
o
Endo treat first, then perio treat 2 months later
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True combined
o
Endo and perio lesions eventually joined at a position on the root
o
Endo treat first, then perio treat 2 months later
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Summary
o
Endo treat completed before perio start
o
Perio treatment 2 months after endo, only if needed
o
Perio condition generally dictates overall prognosis
Longitudinal Tooth Fractures
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Craze Lines
o
Confined to enamel – no discomfort
o
Natural or due to trauma – no treatment necessary, maybe for esthetics
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Fractured Cusp
o
Lack of cusp support from weakened marginal ridge
o
Brief sharp pain on biting, variable cold sensitivity
o
Transillumination and bite tests to ID cusp
o
Pulp test, remove fractured segment, restore tooth
o
79% molar fractures
Mx – 66% buccal, 34% lingual
Mn – 75% lingual, 25% buccal
o
21% premolar fractures