Periapical pathology Flashcards
What are the periapical tissues made up of
- The root of the tooth
- The periodontal ligament space
- The lamina dura
- The alveolar bone
How is the Periodontal ligament seen on a radiograph
Seen as a radiolucent line surrounding the roots of the teeth
Is the periodontal ligament a hard or soft tissue
Soft there fore appears as a radiolucent line
How is the lamina dura represented on a radiograph
Seen as a radio opaque line next to the periodontal space
Why does the lamina dura appear as an opaque line on a radiograph
As it is made up of dense bone
Describe how the periodontal ligament space wold look on a radiograph of a healthy tooth
It would be even surrounding the entire tooth surface
Which two characteristic so we common on when describing bone
- The trabecular pattern
- Density of bone
Describe the bone found in the mandible
Trabecular is thick and horizontally aligned
Describe the bone found in the maxilla
Trabeculae are finer and there’s no predominant pattern
Describe the periapical tissues of deciduous teeth
- Circumscribed area of radiolucency at the apex
- Theres a radio-opaque line of the Lamina dura that is intact around the radicular papilla
- The developing root is funnel shape
What is one of the big problem when assessing periapical pathology on a radiograph
Super imposed shadows may be visible that can be radiolucent or radio-opaque
Give examples of some radiolucent shadows that may be present on a periapical radiographs
- Maxillary antrum
- Nasopalatine foramen
- Mental foramina
What problems can the maxillary antrum present on a radiograph?
The floor of the antrum is a radio opaque line that can obstruct the view of the apices of the UL6 and UL7
What can hinder the evaluation of the apices of the upper anterior teeth on a radiograph
The soft tissue shadow of the nose
How does the soft tissue shadow of the nose appear on a radiograph
Appears as a curved radio density over the apices of the upper anterior teeth
What can obscure the apices of the upper pre molars on radiographs
The zygomatic buttress
How does the zygomatic buttress appears a radiograph
As a radio opaque hockey shaped line in the posterior region the maxilla
What can obscure for apicies of the lower teeth
The mental foramen
How is the mental foramen represented on a radiograph?
It is super imposed on the lower fives
List the 5 cardinal signs of inflammation following pulpal necrosis
- Swelling
- Pain
- Loss of function
- Heat
- Redness
Why does swelling occur after pulpal necrosis
Due to accumulation of inflammatory exudate in the apical pDL
What is the type of inflammatory repose at the apex dependent on
- The infecting organisms including its virulence
- The body defence system
Describe the radiographic presentation of initial acute inflammation
PDL may widen or there be no apparent change
Describe the radiographic presentation when inflammation begins to spread
Loss of radio opaque line of the lamina dura at the apex
Describe the radiographic presentation of further spread of inflammation
Area of bone loss seen at the tooth apex
presence of rarefying osteitis
What does rarefying osteitis mean
Rarefying= radiolucent
Osteitis= Inflammation of bone
Radiolucent inflammation of bone
Describe the radiographic presentation of initial low grade chronic inflammation
No apparent bone destruction but dense sclerotic bone can be seen around the apex called sclerosing osteitis
Name the 2 types of inflammatory peripiacl pathology
- Osteolytic
- Osteosclerotic
What does osteolytic mean
Bone has been bone at the apex of the root
What does Osteosclerotic means?
Bone is laid down at the apex of the root instead of being lost
Describe the radiographic presentation of later stages of chronic inflammation
Circumscribed well defined radiolucent areas of bone loss are seen at the apex surrounded by sclerotic dense bone
What happens in later stages of chronic inflammation
Apical bone is resorbed and destroyed an dose bone is laid down around the area of destruction
periapical granuloma or radicular cysts can also develop
Other than bone loss and healing what are some other inflammatory changes that can be seen on a radiograph
- Pupal sclerosis
- External root resorption
- Internal root resorption
What plural sclerosis?
Obliteration of the root canal
Other than inflammation what else can cause periapical radiolucencies and radio densities
- Benign and malignant bone tumours including metatases
- Lymphoreticular tumours of bone
- Osseous dysplasia
- Hypercementosis
Give some signs of concern when looking at localised areas of infection
- Spiking resorption and an irregular radiolucency with a poorly defined border
- Tooth mobility in the absence of periodontal disease
- Altered sensation or anaesthesia
- Signs and symptoms in the presence of good Endodontic treatment
What type of radiographs do you need before carrying our Endodontic treatment
- A good quality preoperative paralleling periapical
- One good quality paralleling periapical to determine the working length
- A midfll radiograph if you are in doubt about the integrity of the apical constriction
What type of radiographs do you need after carrying out Endodontic treatment
At least one good quality postoperative radiograph to assesses success of the obturation
A Periapical radiograph one year post treatment
What may you still be able to see on a radiographic even if your Endodontics treatment was successful and why
May still be able to see periapical radiolucency because:
- Healing may have occurred with fibrous tissue which may leave residual radiolucency
2. Surgical defect can increase radiolucency initially
