Periapical lesions - chronic Flashcards
Another name for chronic periapical periodontitis?
Periapical granuloma
Why is chronic pp also called periapical granuloma?
Inflammation becomes confined in the shape of a granuloma
Replacement with granulation tissue (incl. bone and periodontal tissue)
When is periapical periodontitis defined as chronic?
Persistent irritation
Resorption of bone
Replacement with granulation tissue (incl. bone and periodontal tissue)
Collagen fibres surrounding granuloma
Granuloma attached to the tooth via capsule
Is the granuloma well localised?
Yes - contained a capsule
What is the contents of a periapical granuloma?
Granulation tissu e
Lymphocytes (T dominant), plasma cells and macrophages
Chlesterol crystals and haemosiderin deposits
Giant cells
What lymphocyte is most common in the periapical granuloma?
T cells
Why are there cholesterol clefts?
Due to breakdown of lists of cells
Cells have a cell membrane and thee are lots of cholesterol in the cell membrane - when cells breakdown, cholesterol is left
Cholesterol is made of fat, when you prepare the tissues you are left with cholesterol clefts
What are cholesterol clefts associated with?
Giant cells try to eat the cholesterol
What appears as brown deposits?
Haemosiderin deposits
What are haemosiderin deposits?
From the breakdown of RBCs
What are cells rests of malassez remenants of?
Hertwigs epithelial rot sheath (rot formation)
How does the granuloma attach to teh root?
Fibrous tissues anchors it
What structure can form into cysts?
Cell rests of malassez
What is shown here?
Anastomosing cords arranged inn oops and arcades
Clinical presentation of chronic periapical periodontitis?
Asymptomatic
Occasional pain upon tooth palpitation and percussion
Percussion produces a dull note due to the lack of resonance - cushioned by granuloma
What is shown in this PA?
Periapical radiolucency showing late stages of PP
How does the early stages of periapical periodontistis appear on a radiograph?
Winding of the periodontal ligament
Why is there variation in the periapical radiolucency?
Different appearance of the borders due to the difference in cellular activity
Sometimes well defined and sometime poorly defined - depends on stage of disease and activity of cells (resorption still going?)
What has occurred i this PA?
Resorption of root as well as PP
Chronic periapical period it’s scan cause bone and root resorption
What happens if you do not treat chronic periapical periodontitis?
The granuloma remains as it is
Enlargement of granuloma
Infection of granuloma
Acute abscess formation
Chronic abscess formation (can be either)
Radicular cysts formation
Osteosclerosis
Hypercementosis
Bone and/or root resorption
What has formed here?
Abscess formation - pt in pain
What is shown here?
Radicular cysts formation - consequence of chronic periapical periodontitis - where the granuloma use to be
What is shown here?
Osteosclerosis
What is shown here?
Hypercementosis - activation of odontoblasts
What can Hypercementosis lead to?
Fusion to bone
Ankylosed / ankylosis
Clinical presentation of an acute periapical abscess?
Rapid onset pain
Redness and swelling of adjacent soft tissues
Tenderness to percussion
Tooth mobility
Cause of acute periapical abscess?
May develop from acute periapical periodontitis
More commonly develops from a periapical granuloma - longstanding periodontistsis
Once pus has formed in the abscess, what are the routes the pus can spread?
May drain though the root canal
May drain into the gingival sulcus
Track formation trough cancellous bone leading to cortex perforation (buccal most common)
Lateral maxillary incisors and palatal roots drain palatally
Pus might form a subperiosteal abscess
Perforation of the periosteum and more track formation
Location of the perforation depends on anatomy
Describe the route of pus through bone?
Move into cancellous bone (spongy)
Perforates cortical bone and cause sinus
Can drain into oral cavity
Intraorally or intraorally
What side if the cortex perforation usually?
Buccally
Palatal roots or anterior teeth will drain lingual or palatally
What happens when pus drains into the buccal cortical plate above or elbow the buccinator muscle?
Spread of the infection into the facial soft tissues
- cellulitis
- soft tissue abscesses that may further track into the skin surface
- associated with scarring and fibrosis
Why is this pt face swollen?
Maxillary abscess
Where can maxillary molars pus drain into?
Maxillary sinus
Sinusitis
What happens if you do not treat the abscess?
Lead to cellulitis - spread of infection and inflammation through facial tissues - not well localised - spreads all over
Pain
Fever
Where can cellulitis lead to when maxillary teeth affected?
Extends towards the eye poses the risk cavernous sinus thrombosis
Upper half of face swollen
Where can cellulitis lead to when mandibular teeth are affected?
Lower half of face swollen
Extension into the submandibular and cervical tissue may lad t respiratory stress
Involvement of deep spaces presents with Pain and trismus rather than facial swelling
What is the worst consqunece of not treating an abscess?
Ludwig’s angina
Severe cellulitis
What does ludwig’s angina involve?
Submandibular, sublingual and submental spaces
What are the clinical manifestations of ludwig’s angina?
Swelling of flor of the mouth
Elevation and posterior displacement of the tongue
Difficulty in eating, swallowing and breathing
Breathing is further distressed if the infection involves the pharynx and larynx
Oedema of the epiglottis poses the risk of suffocation
