ENDO - Periapical Pathology

Question 1

what comes before radiographic examination? (3)

Answer 1

• patient history
• clinical examination
• review prior imaging

Question 2

2 features of normal periapical tissues

Answer 2

PDL space - even width black line around the tooth

Lamina dura - continuous white line around the root

Question 3

what does the PDL space appear as?

Answer 3

radiolucent black line around the tooth

Question 4

what does the lamina dura appear as?

Answer 4

radiopaque white line around the root

Question 5

Describe the Trabeculae in the Mandible and Maxilla

Answer 5

Mandible - thick and horizontal
Maxilla - finer and predominant pattern

Question 6

Describe the Periapical Tissues of Developing Teeth.

Answer 6

Apical Papilla - radiolucency
Lamina Dura - intact
root is funnel shaped

Question 7

be able to see if there is any superimposition of the: radiolucent shadows

maxillary antrum - black lines above

nasopalatine foramen - line between the upper centrals

mental foramina - holes on both side of the jaw under the 5

oral air space

mental fossa - shadowing between alveolar ridge and mental ridge

submandibular fossa - shadowing submandibular

inferior alveolar canal
submandibular fossa

Question 8

be able to see if there is any superimposition of the: radio-opaque shadows

mylohyoid ridge - the ridge right at lower back

external oblique ridge - superior to mylohyoid ridge

zygomatic buttress - u shaped, above the 6

soft tissues of the nose/lip

Question 9

how can you easily find the zygomatic buttress on a radiograph? (3)

Answer 9

radio-opaque
U shaped
usually over the upper 6

Question 10

How does Periapical Inflam Pathology usually come about?

Answer 10

bacterial invasion of root canal system
+
pulp necrosis

Question 11

Describe Steps of Periapical Inflam Pathology (8)

Answer 11

• bacterial ingress via caries, cracks, marginal gaps
• reversible pulpitis
• irreversible pulpitis
• pulp necrosis
• root canal infection
• bacterial and necrotic pulpal product leak out apical foramen
• periapical periodontitis
  = bone resorption
• granulation tissue or cysts

Question 12

How do Granulated Tissues or Cysts Appear on Radiographs?

Answer 12

radiolucency around the apex

Question 13

As well as Bone Resorption, can Bone Formation Occur?

Answer 13

yes

Question 14

Define Osteitis and what it looks like radiographically.

Answer 14

inflammation of the bone due to infection, trauma or disorder

radiograph - diffused opaqueness

Question 15

Define Periodontitis

Answer 15

inflammation of the supporting tissue of the teeth, leading to permanent tissue destruction

Question 16

Be able to know the difference between Apical, Periapical and Peri-Radicular

Question 17

What are the 5 Signs of Inflammation? RCTFD

Answer 17

Heat = Cador
Pain = Dolor
Redness = Rubor
Loss of Function = Function Laesa
Swelling = Tumour

Question 18

is it possible to differentiate between abscess, granuloma or cyst?

Answer 18

no

abscess - acute
granuloma and cysts - chronic

Question 19

Describe how Acute Inflammation presents on a Radiograph and how it Progresses. (3 stages)

Answer 19

Initial
- widening of PDL
- lamina dura intact

Spread
- periapical radiolucency
- loss of apical lamina dura

Further
- bone loss at apex
- described as rarefying osteitis

Question 20

Define Rarefying

Answer 20

radiolucency

Question 21

What is the Clinical Diagnosis of an Abscess.

Answer 21

• pus
• takes 10 days for radiographic appearance to catch up

Question 22

What can An Abscess be Mistaken as?

Answer 22

rarefying osteitis

Question 23

Describe how Chronic Inflammation presents on a Radiograph (2 stages)

Answer 23

Initial
- sclerosing osteitis - dense bone around the apex

Later
- apical bone is resorbed
- dense bone around area of destruction
- periapcial granuloma or radicular cyst

Question 24

What is Sclerosing Osteitis AKA? (2)

Answer 24

Condensing or Focal Sclerosing Osteitis

Question 25

Describe Symptoms of Sclerosing Osteitis

Answer 25

often symptomless

Question 26

Where is Sclerosing Osteitis often Found?

Answer 26

roots of lower 1st molars

Question 27

How can you Tell the Difference between Apical Granuloma and Radicular Cysts?

Answer 27

less than 1cm diameter - 66% granuloma
1-1.5 diameter - 1:1 granuloma or cyst
more than 1.5cm - 66% cyst

Question 28

What is a Endo-Perio Lesion?

Answer 28

involves pulp and periodontal tissue

Question 29

Radiographic Appearance of a Endo-Perio Lesion.

Answer 29

wide PDL
apical pathology

Question 30

What is a Double Dense Shadow?

Answer 30

reflects perforation of the cortices and degree of bone loss

Question 31

What may Follow up After Periapical Pathology?

Answer 31

• External Root Resorption
• Osteomyelitis

Question 32

Describe External Root Resorption

Answer 32

root may look irregular or blunted apex

Question 33

Describe Osteomyelitis

Answer 33

infection inflammation of bone and bone marrow

Question 34

5 Causes of Osteomyelitis

Answer 34

• periapical abscess or granuloma
• surgery
• trauma
• idiopathic
• immunocompromised

Question 35

3 Appearances of Osteomyelitis

Answer 35

• sclerosis
• moth eaten appearance
• periosteal bone formation

Question 36

Although endodontic treatment can be successful, what can persist?

Answer 36

radiolucency of fibrous tissue

Question 37

Apart from Periapical Pathologies, what else can be causing radio opacities and radiolucencies?

Answer 37

hypercementosis
dense bone islands
cemento-osseous dysplasia (FCOD) - benign lesion of bone characterized by the replacement of normal bone by fibrous tissue

Question 38

How can you discover FCOD?

Answer 38

there is yet clear PDL space and lamina dura

so
the bone is resorbed

Question 39

What are Bone Islands?

Answer 39

small dense bone that forms naturally
leave it alone

Question 40

How can you Clarify something is a Bone Island?

Answer 40

take a radiograph and another some time apart, should be the same size and placement