Clinical Radiology - Interpretation of Periapical Conditions

Question 1

Inflammatory conditions of apical periodontium of pulpal origin

Answer 1

Periapical inflammatory disease

Question 2

Irreversible decomposition of the pulp

Answer 2

Pulp necrosis

Question 3

Destruction of microvascular and lymph systems, and ultimately, nerve fibers

Answer 3

Pulp necrosis

Question 4

Rigid dentin walls and lack of collateral circulation; inadequate drainage of inflammatory fluids -> increased pressure on tissues and progressive destruction until entire pulp is necrotized

Answer 4

Pulp necrosis

Question 5

What are the 3 types of irritation of the pulp that can cause pulp necrosis?

Answer 5

Bacterial
Mechanical
Chemical

Question 6

Can pulp necrosis be determined radiographically?

Answer 6

No

Question 7

What conditions may indicate that pulp necrosis is likely present?

Answer 7

Deep restoration
Carious lesions
Fractures

Question 8

Preserve a tooth by removed infected/damaged pulp; prevents or treats periapical inflammatory disease

Answer 8

Endo therapy

Question 9

Steps of endo therapy

Answer 9

1. Access
2. Remove pulp tissues
3. Shape, cleanse, decontaminate canals w/ files + irrigating solutions
4. Fill canals w/ gutta percha

Question 10

What are the 3 periapical lesions? Are they all treated the same way?

Answer 10

Abscess
Granuloma
Cyst

Yes, they are all treated the same way

Question 11

Synonym for periapical lesion

Answer 11

Apical periodontitis

Question 12

T/F: Periapical inflammatory disease can be acute or chronic, and asymptomatic or symptomatic

Answer 12

True

Question 13

Bacteria and products of degradation can reach the periapical tissues

Answer 13

Pulp necrosis

Question 14

In inflammation, there is an ___________ of bone metabolism

Answer 14

imbalance

Question 15

Osteoblastic bone production is favored

Answer 15

Sclerosis (sclerosing osteitis)

Question 16

Osteoclastic bone resorption is favored

Answer 16

Rarefaction (rarefying osteitis)

Question 17

What are the 4 modulating factors of inflammation/the balance of bone metabolism?

Answer 17

Pathogenicity of microorganism
Host immune response
Tissue vascularity
Time

Question 18

Periapical region of a tooth with pulp necrosis

Answer 18

Epicenter

Question 19

Radiolucencies at inter-radicular bone are associated with what?

Answer 19

Accessory canal

Question 20

T/F: Sometimes, a potential condition (like caries, deep restoration, or fracture) that leads to necrosis is NOT clear

Answer 20

True

Question 21

How do you determine pulp necrosis?

Answer 21

Pulp vitality test

Question 22

What is the result of pulp vitality test?

Necrosis

Answer 22

Negative

Question 23

What is the result of pulp vitality test?

Vital

Answer 23

Positive

Question 24

T/F: Early or acute periapical inflammatory disease may show no radiographic signs

Answer 24

True

Question 25

What are early radiographic signs of periapical inflammatory disease?

Answer 25

Widening of PDL space Loss of lamina dura

Question 26

As the periapical lesion enlarges, bone rarefraction is observed. What does this look like?

Answer 26

Apical radiolucency

Question 27

What does diffuse mean?

Answer 27

Poorly defined

Question 28

Which are well-defined and which are diffuse? Abscesses Granulomas Cysts

Answer 28

Abscesses = diffuse Granulomas = well-defined Cysts = well-defined + corticated

Question 29

Periapical inflammatory diseases can have effects on surrounding tissues seen as peripheral areas of sclerosing osteitis. What does this look like on an X-Ray?

Answer 29

Radiopacity

Question 30

Another name for peripheral areas of sclerosing osteitis

Answer 30

Condensing osteitis

Question 31

What is another effect peripapical inflammatory disease has on surrounding structures, specifically within the maxillary sinus?

Answer 31

Regional mucositis

Question 32

Inflammatory mediators stimulate the adjacent mucosal lining

Answer 32

Regional mucositis in maxillary sinus

Question 33

What is another effect peripapical inflammatory disease has on surrounding structures, specifically on the root?

Answer 33

Root resorption

Question 34

Inflammatory rxn in periapical region may trigger odontoclastic activity

Answer 34

Root resorption

Question 35

What is another effect peripapical inflammatory disease has on surrounding structures, especially if the infection has to do with a primary tooth?

Answer 35

Disrupted eruption of underlying permanent tooth

Question 36

Localized enamel defect on permanent teeth caused by periapical disease of deciduous tooth

Answer 36

Turner hypoplasia

Question 37

Reduction in quality, presenting as pits, grooves, thin, or missing enamel. Results from changes during the stage of matrix formation

Answer 37

Enamel hypoplasia

Question 38

The extension of defect in turner hypoplasia depends on severity of the __________ or __________

Answer 38

infection; trauma

Question 39

A more widespread response to bone inflammation

Answer 39

Osteomyelitis

Question 40

Can affect cancellous bone, cortical bone, and periosteum

Answer 40

Osteomyelitis

Question 41

Acute or chronic osteomyelitis? Pain, swelling of adjacent tissues, fever, lymphadenopathy, leukocytosis

Answer 41

Acute osteomyelitis

Question 42

Acute or chronic osteomyelitis? Tooth mobility, sensitivity to percussion, purulent drainage

Answer 42

Acute osteomyelitis

Question 43

Acute or chronic osteomyelitis? Can be a sequela of inadequately treated acute phase

Answer 43

Chronic osteomyelitis

Question 44

Acute or chronic osteomyelitis? Less severe symptoms

Answer 44

Chronic osteomyelitis

Question 45

Ill-defined radiolucency in bone

Answer 45

Osteomyelitis

Question 46

Fragment of diseased bone that may have undergone necrosis as a consequence of ischemic injury

Answer 46

Sequestrum

Question 47

Sequestrum is present in which disease?

Answer 47

Osteomyelitis

Question 48

Radiopaque islands of bone on a radiolucent backround

Answer 48

Sequestrum

Question 49

Dense fibrous membrane covering surfaces of bone, consisting of outer fibrous layer and inner cellular layer

Answer 49

Periosteum

Question 50

New bone formation of bone surface as a result of periosteal stimulation

Answer 50

Periosteal rxn

Question 51

Periosteal rxn is seen in which disease?

Answer 51

Osteomyelitis

Question 52

Which disease? CBCT may show increased width of body of mandible in affected area, increased bone density, and perforation of buccal cortical plate

Answer 52

Osteomyelitis

Question 53

Which disease? Altered bone metabolism - cancellous bone is replaced by a mix of fibrous CT containing varying amounts of immature, abnormal bone

Answer 53

Periapical cemento-osseous dysplasia (PCOD)

Question 54

Which disease? Lesion does not arise from PDL space; appearance of PDL may vary

Answer 54

Periapical cemento-osseous dysplasia (PCOD)

Question 55

Which disease? In early stages, there is a radiolucency that mimics periapical inflammatory disease, but the tooth is vital

Answer 55

Periapical cemento-osseous dysplasia (PCOD)

Question 56

Which disease? In more mature stages, there will be a mixed radiolucent and radiopaque appearance

Answer 56

Periapical cemento-osseous dysplasia (PCOD)

Question 57

Does Periapical cemento-osseous dysplasia (PCOD) require treatment?

Answer 57

NO

Question 58

Which disease? In very late stages, it is almost completely radiopaque with a thin radiolucent ring around it

Answer 58

Periapical cemento-osseous dysplasia (PCOD)

Question 59

Which disease? Usually affects the anterior mandible and is more common in non-caucasian women

Answer 59

Periapical cemento-osseous dysplasia (PCOD)

Question 60

Which disease? Typically asymptomatic; may affect single or multiple teeth, and may merge

Answer 60

Periapical cemento-osseous dysplasia (PCOD)

Question 61

Which disease? NOT related to periapical inflammatory disease

Answer 61

Periapical cemento-osseous dysplasia (PCOD)

Question 62

What is it called when the cemento-osseous dysplasia presents as a single lesion in the posterior region?

Answer 62

Focal cemento-osseous dysplasia

Question 63

What is it called when the cemento-osseous dysplasia presents as multiple bilateral lesions, possibly in both jaws?

Answer 63

Florid cemento-osseous dysplasia

Question 64

Which disease? Affects women of African descent

Answer 64

Florid cemento-osseous dysplasia

Question 65

Which disease? Asymptomatic, but in some cases, expansion and pain are present

Answer 65

Florid cemento-osseous dysplasia

Question 66

Which disease? No tx required unless the dysplastic bone becomes exposed

Answer 66

Florid cemento-osseous dysplasia

Question 67

Which disease? If dysplastic bone becomes exposed, osteomyelitis may develop, with mucosal ulceration and fistulous tracts with suppuration and pain. Tx involves surgical resection and ABs (poor diffusion due to avascular nature)

Answer 67

Florid cemento-osseous dysplasia

Question 68

Which disease? Localized growth of cortical bone into the cancellous bone space

Answer 68

Idiopathic osteosclerosis

Question 69

Which disease? Well-defined periapical radiopacity

Answer 69

Idiopathic osteosclerosis

Question 70

What is another name for Idiopathic osteosclerosis?

Answer 70

Dense bone island/enostosis

Question 71

Which disease? Well-defined apical radiopacity found in mandibular molar and premolar areas

Answer 71

Idiopathic osteosclerosis

Question 72

Which disease? Persistent radiolucency after successful endo therapy

Answer 72

Fibrous scar

Question 73

Which disease? Dense CT that is radiolucent, surrounded by normal bone

Answer 73

Fibrous scar

Question 74

Which disease? The surrounding healing bone may present concentric or radiating patterns

Answer 74

Fibrous scar

Question 75

Which disease? Clinical correlation is important for diagnosis; make sure to compare current and previous images

Answer 75

Fibrous scar

Question 76

What is the SLOB rule?

Answer 76

Same = lingual Opposite = buccal