endodontics 2020/2021 PA pathology

Question 1

describe the normal PA tissues of the adult teeth

Answer 1

there is a even radiolucent line around the whole PDL membrane space

Question 2

what other structure can we see around the PDL in a normal healthy tooth

Answer 2

a lamina dura- radiopaque white line

Question 3

what does the density of bone look like in the maxilla

Answer 3

the trabecular pattern is much finer and no pattern

Question 4

what does the density of bone look like in the mandible

Answer 4

horizontal trabecular pattern

Question 5

what does the periodical tissues of deciduous teeth look like

Answer 5

the developing root is funnel shaped
the radiopaque line of the lamina dura and it is intact around the radicular papilla
circumscribed radiolucency at the apex

Question 6

what are some radiolucent shadows seen on the x ray

Answer 6

the maxillary antrum
nasopalatine foramen
mental foramen

Question 7

what are some radiopaque shadows

Answer 7

mylohyoid ridge
zygoma body
areas of the sclerotic bone

Question 8

what re the 5 signs of inflammation

Answer 8

calor 
dolor 
tumour 
function laesa 
rubor

Question 9

what is the type of inflammatory response dependant on

Answer 9

the infection organism and virulence

and the body defence system

Question 10

how do we differentiate between acute PA abscess and chronic apical granuloma or radicular cysts

Answer 10

cannot tell the difference radiographically

Question 11

how does acute apical periodontitis present radiographically

Answer 11

inflammatory exudate accumulates in the PDL space-

shown as widening of the PDL or no apparent changes

Question 12

what changes occur when inflammation occurs

Answer 12

• resorption and destruction of the apical bone
• PA abscess maybe
• loss of the radiopaque line of the lamina dura at the apex of the tooth

Question 13

what can further spread of the infection lead to

Answer 13

rarefying osteitis - an ill defined radiolucency

Question 14

define an abscess

Answer 14

the clinical diagnosis of the presence of pus

Question 15

how long does it take for the radiographic appearance to catch up with the symptoms

Answer 15

approx ten days

Question 16

what might initial low grade chronic inflammation look like

Answer 16

Minimal destruction of the apical bone

The body’s defence systems lay down dense bone in the apical region in response to necrotic pulp

Radiographically- no apparent bone destruction but dense sclerotic bone ( sclerosing osteitis) around the apex

Question 17

describe sclerosis osteitis

Answer 17

+/- radiolucency
might be a halo round the area of rarefying osteitis
often symptomless

Question 18

where is scleorising osteitis seen

Answer 18

usually lower first molar roots

Question 19

what are the types of inflammatory periodical pathology

Answer 19

osteolytic

osteosclerotic

Question 20

what re the later stages of chronic inflammation

Answer 20

apical bone is resorbed and destroyed

Question 21

what are the later stages of chronic inflammation radiographically

Answer 21

circumscribed

well defined radiolucent area of bone loss at the apex

Question 22

what does a periapical granuloma look like

Answer 22

Showing a radiolucency at the apex as well as having a well defined corticated border(white radio dense line which surrounds an area of bone destruction)- this is a sign of healing

Question 23

what is the difference between apical granulomas and radicular cysts

Answer 23

they are both largely asymptomatic unless secondarily infected

Question 24

how big are granulomas

Answer 24

if less than 1cm in diameter then 2/3 are granulomas

Question 25

if the size is 1-1.5cm is it a granuloma and cyst

Answer 25

equal chance of granuloma or cyst

Question 26

if the size is greater than 1.5cm then what can it be

Answer 26

2 out of three chance it is a cysts

Question 27

what are some other causes of PA radiolucency and radio densities

Answer 27

• Benign and malignant bone tumours including metatases
• Lymphoreticular tumours of bone
• Osseous dysplasia
Hypercementosis

Question 28

what are the radiographies we take during endodontic procedures

Answer 28

A good quality parallel periapical- using an endo ray
At least one good PA to see the working length
A midfill radiograph to check the integrity of the apical constriction
One radiograph at the end of obturation
A PA at one year post op- greatest incidence of healing or progressive periodontitis