endodontics 2020/2021 PA pathology Flashcards
describe the normal PA tissues of the adult teeth
there is a even radiolucent line around the whole PDL membrane space
what other structure can we see around the PDL in a normal healthy tooth
a lamina dura- radiopaque white line
what does the density of bone look like in the maxilla
the trabecular pattern is much finer and no pattern
what does the density of bone look like in the mandible
horizontal trabecular pattern
what does the periodical tissues of deciduous teeth look like
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
what are some radiolucent shadows seen on the x ray
the maxillary antrum
nasopalatine foramen
mental foramen
what are some radiopaque shadows
mylohyoid ridge
zygoma body
areas of the sclerotic bone
what re the 5 signs of inflammation
calor dolor tumour function laesa rubor
what is the type of inflammatory response dependant on
the infection organism and virulence
and the body defence system
how do we differentiate between acute PA abscess and chronic apical granuloma or radicular cysts
cannot tell the difference radiographically
how does acute apical periodontitis present radiographically
inflammatory exudate accumulates in the PDL space-
shown as widening of the PDL or no apparent changes
what changes occur when inflammation occurs
- 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
what can further spread of the infection lead to
rarefying osteitis - an ill defined radiolucency
define an abscess
the clinical diagnosis of the presence of pus
how long does it take for the radiographic appearance to catch up with the symptoms
approx ten days
what might initial low grade chronic inflammation look like
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
describe sclerosis osteitis
+/- radiolucency
might be a halo round the area of rarefying osteitis
often symptomless
where is scleorising osteitis seen
usually lower first molar roots
what are the types of inflammatory periodical pathology
osteolytic
osteosclerotic
what re the later stages of chronic inflammation
apical bone is resorbed and destroyed
what are the later stages of chronic inflammation radiographically
circumscribed
well defined radiolucent area of bone loss at the apex
what does a periapical granuloma look like
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
what is the difference between apical granulomas and radicular cysts
they are both largely asymptomatic unless secondarily infected
how big are granulomas
if less than 1cm in diameter then 2/3 are granulomas
if the size is 1-1.5cm is it a granuloma and cyst
equal chance of granuloma or cyst
if the size is greater than 1.5cm then what can it be
2 out of three chance it is a cysts
what are some other causes of PA radiolucency and radio densities
• Benign and malignant bone tumours including metatases
• Lymphoreticular tumours of bone
• Osseous dysplasia
Hypercementosis
what are the radiographies we take during endodontic procedures
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
