Lecture 4- Pulpal & Periapical Disease & Periapical Radiolucencies Flashcards
Four aspects of pulpal interpretation:
- size
- secondary dentin
- pulp stones/ pulpal sclerosis
- internal/external resoprtion
Describe the pulp chamber of a younger patient:
larger pulp chamber & RC space is larger
How old is this patient?
pulp chamber of kid
Why might a younger patient be more prone to carious exposures of the pulp?
Larger pulp horns- pulp is closer to the occlusal surface
How old is this patient?
pulp chamber of kid
As we age, our pulp chambers:
shrink
How old is this patient?
older- small pulp chamber & secondary dentin formation
As the pulp chamber gets smaller, it usually:
maintains shape
Why does the pulp chamber get smaller with age?
part of aging process + stress of occlusal forces
(secondary dentin formation)
What do you notice in this image? What might be the reason?
The pulp chamber of tooth #7 is larger than the pulp chambers of the adjacent teeth. We can see a periapical radiolucency on #7. This tooth probably became non-vital at a young age.
When the tooth became non-vital, so the secondary dentin did not form
Why does the pulp chamber appear non-existent?
due to secondary dentin formation- probably still a pulp chamber in there just very small
Comparing the first & second molars, we can note:
localized secondary dentin formation- distal pulp horn of 1st molar- This can also be referred to as tertiary dentin formation that is formed due to the carious lesion on the 1st molar.
Additional dentin formation caused by irritation from deep carious lesion:
secondary/tertiary dentin formation
How can we tell if tertiary dentin is formed (what distinguished this from primary dentin?)
shape of pulp chamber is changed
We generally refer to the calcifications in the pulp as:
pulp stones
Describe pulp stones:
- occur in the RC space or pulp chamber
- can be single or multiple
- can vary in size
- teeth are still vital (no clinical significance unless trying to do endo)
What can be seen in this radiograph?
pulp stones in the molars
What can be seen in the radiograph?
pulp stones
A more widespread diffuse form of pulp stones, where the calcification can almost completely fill the pulp chamber and often times fills the root canal spaces:
pulpal sclerosis
What can be seen in the following image?
pulpal sclerosis
Inflammation of the pulp that causes resorption of the dentin in the root and it starts from within the pulp and goes outward
Internal root resoprtion
Describe the margins in internal root resoprtion:
smooth and well defined
Internal root resorption is inflammation of the pulp that causes resorption of the ___ in the root. It starts from within the pulp and goes outward.
dentin
The area of internal resoprtion of a root is typically described as:
ovoid or round
What is the treatment for internal root resoprtion?
RCT (to try to stop the resorptive process)
What can be seen in the following radiograph?
internal root resorption
What can be seen in the following radiograph?
internal root resoprtion
(this image also has some external root resorption)
Root resorption caused by EXTERNAL forces
External root resorption
With external root resorption, the remaining surfaces are usually:
smooth
As the tooth resorbs in external root resorption, the PDL and lamina dura:
move with the resorbing root
What can be seen in the following radiograph?
external root resoprtion
You see this benign tumor in a patient, and you know that its slow growing due to the displacement of teeth. What else can be seen (that has occurred due to this tumor)
external root resoprtion
What can be see in the following radiograph?
external root resorption
(associated with an inflammatory PA lesion)
T/F- Internal root resorption always requires therapy. External root resorption may or may not require treatment
True
List some causes of periapical radiolucencies:
- periapical abscess
- periodical granuloma
- periapical cyst
- residual/recurrent cyst
- periapical memento-osseous dysplasia
- fibrous healing defect
Periapical INFLAMMATORY lesions include: (3)
- peripapical abscess
- peripalical granuloma
- periapical cyst
- Reversible/irreversible pulpitis
- Acute apical abscess
These are both examples of:
Acute pulpal/periapical disease
This patient comes in on E-chair and is complaining of periapical pain of the second molar. You take a radiograph, and note the periodontal ligament space and lamina dura are intact.
Radiographically you may not see any evidence of disease here.
reversible puulpitis
- PDL space thickening
- discontinuity of lamina dura
- periapical radiolucency
these findings are characteristic for:
apical abscess
What can yo see in this radiograph?
apical abscess
What is the first sign you may see on a radiograph for an apical abscess?
PDL space widening
What is the second radiographic signs for an apical abscess?
discontinuity of the lamina dura
What is the the third radiographic signs for an apical abscess?
periapical radiolucency
What do we see looking at the mesial apex of the first molar?
slight PDL widening (mesial root of 1st molar) , but the lamina dura is intact
What can we see in the following radiograph?
apical abscess (the start of one)
Once you have an apical abscess, its no longer is considered:
acute
What can be seen in the following radiograph? Describe it
- Ill defined radiolucency at apex of tooth
- Apical abscess
List the chronic periapcial inflammatory lesions: (4)
- chronic apical abscess
- periapical granuloma
- periapical cyst
- periapical rarefying osteitis
- chronic apical abscess
- periapical granuloma
- periapical cyst
- periapical rarefying osteitis
The following are:
chronic periapical inflmattory lesions
Three radiographic lesions that are often indistinguishable:
- chronic apical abscess
- periapical granuloma
- periapical cyst
Instead of saying this is either a
1. chronic apical abscess
2. periapical granuloma
3. periapical cyst
we might just say:
this is a periapical rarefying osteitis
What is the treatment for the following?
- chronic apical abscess
- periapical granuloma
- periapical cyst
RCT
When you have chronic apical abscess you may or may not see:
sclerotic bone
What can be seen in the following radiograph? What is this characteristic of?
sclerotic bone - chronic apical abscess
What can be seen in the following radiograph? What is this characteristic of?
sclerotic bone - chronic apical abscess
A periapical radiolucency that instead of being filled with inflammatory fluid or pus, its filled with granulation type tissue:
periapcial granuloma
Periapical granulomas often develop from:
periapical abscesses
Radiographically, the appearance of a periapical granuloma is quite:
variable
What can be seen in the following image?
periapical granuloma
Periapical ____ often form from periapical granulomas
Periapical cysts
What can bet seen in the following image?
periapical cyst
Cystic degeneration of a periapical granuloma which results in a fluid filled cavity:
periapical cyst
Periapical cyst tend to be ____ in shape:
rounded (hydraulic)
What can be seen in the pano?
periapical cyst
