DENT 267: LO6 LS3- Describe Periodontal Cysts & Endodontic Lesions

periodontal cyst

-abnormal pathologic sac or cavity that is lined w/ epithelium and enclosed in a CT capsule

-gingival & periodontal cysts are odontogenic cysts that develop from remnants of odontogenic epithelium

-odontogenic developmental cyst

-radiolucent (may resemble a perio abscess)

-asymptomatic

-there may be swelling of the gingiva as well

-tx is usually surgical removal

-histologically appears as a hollow space lined w/ epithelium

-osteoclastic bone resorption may be present surrounding the cyst

gingival cyst

-resembles a mucocele

-vesicle or bulla

-painless, marginal and attached gingiva

-tx is usually surgical removal

-extraosseous

-mandibular cuspid/bicuspid region

what should be done with a periodontal cyst?

-rule out perio and endo problems

-tx is surgical removal and biopsy

lesion of endodontic origin

-may have a primary endodontic lesion w/ secondary periodontal involvement

-lesion of endodontic origin (LEO)

-etiology of pulpal inflammation usually is dental caries

-may be trauma, deep restoration

-typically endo treatment will resolve the infection

endo lesions

-not that common in clinical practice but may severely compromise the tooth and are one of the most challenging problems faceed by clinicians

-may have a primary periodontal lesion w/ secondary endodontic involvement

-periodontal disease may cause inflammation of the pulp by spreading through lateral canals and/or dentinal tubules

-causes include endo and/or perio infections, root trauma and/or iatrogenic factors (root perforations during endo tx or post preparations, root fractures due to trauma, root resorption)

perio-endo lesion

-"true" combined lesion

-both pulpal and periodontal disease are present independently and each disease may progress until the lesions unite

care plan for perio-endo lesion

-perio & endo therapy are both indicated

-endo therapy should be done first

-re-eval after a few months before proceeding w/ periodontal tx as lesion (bone loss) may be eliminated within that time

-perio therapy and a need to determine pulpal vitality

-refer to dentist for dx

-consider amount of remaining bone support

-whether canals are negotiable

-is the tooth restorable? are there root fractures?

-implant or fixed prosthesis a better option?