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The American Association of Endodontics has just released a position paper on Maxillary Sinusitis of Endodontic Origin (MSEO).  These are findings that have always been observed related to endodontic pathosis.  With the more common use of CBCT, the periapical osteoperiostitis and periapical mucositis are more frequently observed.  The clinician now has the resource and proper terminology to describe these findings and appropriately treat them.  Our ENT and MD colleagues will need to be informed of this disease process as it relates to sinusitis.  I will post commonly seen examples in the next few weeks.  Dzuy

American Association of Endodontics MSEO Position Statement:  http://www.seattle-endo.com/referring-doctors/resources-treatment-guidelines/

Examples of periapical osteoperiostitis:

Tooth #2. Pulpal diagnosis of necrotic and associated periapical radiolucency and periapical osteoperiostitis.

Tooth #14. A previously treated tooth with a diffuse radiolucency into the sinus.

CBCT shows the periapical periostitis and associated mucositis into the sinus. Proper treatment of the endodontic pathosis will resolve the sinus pathosis.

Coronal section of tooth #14.

To successfully treat endodontic infections, the clinician needs to accurately assess etiology, diagnosis and prognosis.  One of the challenges the endodontist will face is the “perio-endo” lesion.  In order to accurately access prognosis, the clinician needs to determine if the peri-radicular infection is related to periodontitis, endodontics, or both.  The most important tool in assessing this is the probing depth and pattern related to the lesion.  With an accurate assessment, treatment of these lesions can return teeth to normal function.  The below x-rays are from initial, treatment, 4 month recall, and 1 year recall.

Canal ramifications, including apical deltas and lateral canals, are common features of mandibular molar anatomy (DeDeus, 1975). Lateral lesions may form if an endodontic infection affects the periodontal tissues at the exits of large lateral canals. It remains unclear if expelling obturation material into lateral canals (as seen in the post-op PA) is necessary for the lesions to heal or just a way to highlight their presence (Ricucci and Siqueira, 2010).

A picture of our team in the hallway.  Thank you very much to Lori Saleba, Dorrie Brennick, Vasily “Billy” Shadrin, and Brandon Anderson for making this happen!  Now the fun begins!

After many months of planning and work, we are almost done with construction!  We plan to move in on April 2, 2018 and getting prepared to see patients in downtown Seattle!

Variations in root anatomy are common and knowledge of these variations is the key to successful endodontic therapy as the ability to identify, find, and treat these root canals may prevent future problems.