basic Endodontics Flashcards
In Classification, diagnosis and clinical manifestations of apical periodontitis PAUL V. ABBOTT 2004 Endodontic topics
how long did it take bacterial infection to render the canals void of pulp in teeth with closed and open apices?
2months - open apex
1month - closed apex
In Classification, diagnosis and clinical manifestations of apical periodontitis PAUL V. ABBOTT what did Abbott quote Sundqvist as having found?
Sundqvist (19) confirmed that periapical lesions were found in 18 of 19 cases where microbes were present in the canal and the size of the periapical radiolucency was directly related to the number of strains that could be isolated from the affected tooth.
When can periodontal disease without endodontic disease mimic apical periodontitis ?
Periapical radiographs may falsely suggest an area of apical periodontitis without infection of the root canalsystem when there is extensive periodontal disease andthe pocket has extended beyond the level of the rootapex
In this situation, substantial breakdown of the supporting tissues and loss of bone (either labially orlingually) creates a radiolucency, which is superimposed over the periapical region giving the appearance of apical periodontitis
In Classification, diagnosis andclinical manifestations of apical periodontitis PAUL V. ABBOTT 2004 Endodontic topics
what does Abbott propose as a classification system?
Table2. A clinical classification of the status of the periradicular tissues.
(a) Clinically normal periapical/periradicular tissues
(b) Apical periodontitis-Acute:Primary Secondary (or acute exacerbation)-Chronic: Granuloma Condensing osteitis
(c) Periapical cyst-True cyst, Pocket cyst
(d) Periapical abscess-Acute: Primary, Secondary- Chronic
(e) Facial cellulitis
(f) Extra-radicular infection
(g) Foreign body reaction
(h) Periapical scar
(i) External root resorption-Surface-Inflammatory-Replacement-Invasive-Pressure-Orthodontic-Physiological
In Classification, diagnosis andclinical manifestations of apical periodontitis PAUL V. ABBOTT 2004 Endodontic topics what does abbott quote as Nair’s 1997 finding regarding the presence of epithelium in apical periodontitis versus in true cysts?
Nair found over 50% of apical periodontitis lesions had epithelium present on histopathological sectioning and subsequently the mere presence of epithelium was insufficient to make a diagnosis of a cyst.
Nair proposed that peripaical lesions must be examined in order to determine whether the epithelium forms a complete capsule around the periphery of the lesion and whether there is any communication with the root canal system
What defines a periapical pocket cyst?
A sac-like epithelium-lined cavity that is open to, and continuous with, the root canal
What defines a true periapical cyst?
A true cyst is completely enclosed by the epithelial lining and there is no communication with the root canal
This is important as if the cyst exists separate to the root canal system then endodontic therpy will not resolve the lesion it will need to be treated separately.
Define a normal periodonteum
The tooth is not tender to percussion or pressure, and there is no tenderness to palpation of the mucosa overlying the periapical region. There is no swelling and there are no symptoms noted by the patient. Radiographically, the lamina dura is intact and the perio-dontal ligament space has a normal and consistent width around the entire root(s) of the tooth. The width of the periodontal ligament space should also be similar to that of the adjacent teeth
Other than radiolucency how might chronic apical periodontitis present?
How is this distinguished radiographically?
As condensing osteitis or idiopathic bone sclerosis.
This can be easily distinguished from other chronic periapical conditions by its radiographic appearance since the periapical bone will appear more radiopaque than normal bone. Some cases may also have a slightly widened periodontal ligament space between the tooth root and the radiopacity.
In Classification, diagnosis and clinical manifestations of apical periodontitis PAUL V. ABBOTT 2004 Endodontic topics
what is the recommendation for obturation material extruded beyond the apex of the tooth into the periapical region where there is concern of a foreign body reaction causing apical periodontitis
If there is a radiolucency present in conjunction with extruded root filling material, then healing cannot normally be attained by orthograde endodontic re-treatment. If this lesion has been caused by a foreign body reaction- meaning the obturation material extruded into the periapical region. Ideally in such a case, the periapical region should be monitored radiographically for several years to determine whether it heals before surgery is even considered
In Classification, diagnosis and clinical manifestations of apical periodontitis PAUL V. ABBOTT 2004 Endodontic topics
What 4 factors should be considered for every endodontic examination?
- the status of the pulp
- the status of the root canal
- the status of the periapical tissues
- the causes(s) of the condition(s).
What is the recommended limitation to scaling time/tooth for ultrasonic scalers?
Verez- fraguela’s study JVD 2000 recommended that an ultrasonic scaler be used for no longer than 30 seconds per tooth.
pulp necrosis thought to be the result of the resonance effect on the pulp resulted from 30 seconds of continuous use of the US scaler without water cooling . Acute pulpitis was evident after 15 days when this occurred
What is depicted here and how has it occurred ?
What treatment should be applied?
Hyperplastic pulpitis
The pulp has attempted to respond to a complicated crown fracture and as a result the resulting granulation tissue has occluded and overgrown the fracture site.
the pulp is generally in the terminal stage of change from vital to non vital- root canal therapy is indicated.
What is required to make a definitive diagnosis of apical periodontitis
histopathology
What are the five groups of apical periodontitis as categorized by WHO?
- acute apical periodontitis of pulpal origin
- chronic apical periodontitis
- periapical abcess with sinus
- periapical abcess without sinus
- radicular cyst
When should teeth with root frctures be removed?
When the coronal segment is unstable and cannot be stabilised causing periodontal disease to ensue.
strangulation of the pulp may occur and may warrant RCT
According to Wiggs’s what are the different types of endodontic /periodntic lesions?
primary endodontic
primary periodontal
primary periodontal secondary endodontic
primary endodontic with secondary periodontic
combined endodontic periodontic lesions
concomitant endodotnic and periodontic
