Periapical pathology

Question 1

What are the periapical tissues made up of

Answer 1

1. The root of the tooth
2. The periodontal ligament space
3. The lamina dura
4. The alveolar bone

Question 2

How is the Periodontal ligament seen on a radiograph

Answer 2

Seen as a radiolucent line surrounding the roots of the teeth

Question 3

Is the periodontal ligament a hard or soft tissue

Answer 3

Soft there fore appears as a radiolucent line

Question 4

How is the lamina dura represented on a radiograph

Answer 4

Seen as a radio opaque line next to the periodontal space

Question 5

Why does the lamina dura appear as an opaque line on a radiograph

Answer 5

As it is made up of dense bone

Question 6

Describe how the periodontal ligament space wold look on a radiograph of a healthy tooth

Answer 6

It would be even surrounding the entire tooth surface

Question 7

Which two characteristic so we common on when describing bone

Answer 7

1. The trabecular pattern
2. Density of bone

Question 8

Describe the bone found in the mandible

Answer 8

Trabecular is thick and horizontally aligned

Question 9

Describe the bone found in the maxilla

Answer 9

Trabeculae are finer and there’s no predominant pattern

Question 10

Describe the periapical tissues of deciduous teeth

Answer 10

1. Circumscribed area of radiolucency at the apex
2. Theres a radio-opaque line of the Lamina dura that is intact around the radicular papilla
3. The developing root is funnel shape

Question 11

What is one of the big problem when assessing periapical pathology on a radiograph

Answer 11

Super imposed shadows may be visible that can be radiolucent or radio-opaque

Question 12

Give examples of some radiolucent shadows that may be present on a periapical radiographs

Answer 12

1. Maxillary antrum
2. Nasopalatine foramen
3. Mental foramina

Question 13

What problems can the maxillary antrum present on a radiograph?

Answer 13

The floor of the antrum is a radio opaque line that can obstruct the view of the apices of the UL6 and UL7

Question 14

What can hinder the evaluation of the apices of the upper anterior teeth on a radiograph

Answer 14

The soft tissue shadow of the nose

Question 15

How does the soft tissue shadow of the nose appear on a radiograph

Answer 15

Appears as a curved radio density over the apices of the upper anterior teeth

Question 16

What can obscure the apices of the upper pre molars on radiographs

Answer 16

The zygomatic buttress

Question 17

How does the zygomatic buttress appears a radiograph

Answer 17

As a radio opaque hockey shaped line in the posterior region the maxilla

Question 18

What can obscure for apicies of the lower teeth

Answer 18

The mental foramen

Question 19

How is the mental foramen represented on a radiograph?

Answer 19

It is super imposed on the lower fives

Question 20

List the 5 cardinal signs of inflammation following pulpal necrosis

Answer 20

1. Swelling
2. Pain
3. Loss of function
4. Heat
5. Redness

Question 21

Why does swelling occur after pulpal necrosis

Answer 21

Due to accumulation of inflammatory exudate in the apical pDL

Question 22

What is the type of inflammatory repose at the apex dependent on

Answer 22

1. The infecting organisms including its virulence
2. The body defence system

Question 23

Describe the radiographic presentation of initial acute inflammation

Answer 23

PDL may widen or there be no apparent change

Question 24

Describe the radiographic presentation when inflammation begins to spread

Answer 24

Loss of radio opaque line of the lamina dura at the apex

Question 25

Describe the radiographic presentation of further spread of inflammation

Answer 25

Area of bone loss seen at the tooth apex presence of rarefying osteitis

Question 26

What does rarefying osteitis mean

Answer 26

Rarefying= radiolucent Osteitis= Inflammation of bone Radiolucent inflammation of bone

Question 27

Describe the radiographic presentation of initial low grade chronic inflammation

Answer 27

No apparent bone destruction but dense sclerotic bone can be seen around the apex called sclerosing osteitis

Question 28

Name the 2 types of inflammatory peripiacl pathology

Answer 28

1. Osteolytic 2. Osteosclerotic

Question 29

What does osteolytic mean

Answer 29

Bone has been bone at the apex of the root

Question 30

What does Osteosclerotic means?

Answer 30

Bone is laid down at the apex of the root instead of being lost

Question 31

Describe the radiographic presentation of later stages of chronic inflammation

Answer 31

Circumscribed well defined radiolucent areas of bone loss are seen at the apex surrounded by sclerotic dense bone

Question 32

What happens in later stages of chronic inflammation

Answer 32

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

Question 33

Other than bone loss and healing what are some other inflammatory changes that can be seen on a radiograph

Answer 33

1. Pupal sclerosis 2. External root resorption 3. Internal root resorption

Question 34

What plural sclerosis?

Answer 34

Obliteration of the root canal

Question 35

Other than inflammation what else can cause periapical radiolucencies and radio densities

Answer 35

1. Benign and malignant bone tumours including metatases 2. Lymphoreticular tumours of bone 3. Osseous dysplasia 4. Hypercementosis

Question 36

Give some signs of concern when looking at localised areas of infection

Answer 36

1. Spiking resorption and an irregular radiolucency with a poorly defined border 2. Tooth mobility in the absence of periodontal disease 3. Altered sensation or anaesthesia 4. Signs and symptoms in the presence of good Endodontic treatment

Question 37

What type of radiographs do you need before carrying our Endodontic treatment

Answer 37

1. A good quality preoperative paralleling periapical 2. One good quality paralleling periapical to determine the working length 3. A midfll radiograph if you are in doubt about the integrity of the apical constriction

Question 38

What type of radiographs do you need after carrying out Endodontic treatment

Answer 38

At least one good quality postoperative radiograph to assesses success of the obturation A Periapical radiograph one year post treatment

Question 39

What may you still be able to see on a radiographic even if your Endodontics treatment was successful and why

Answer 39

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