Periapical Pathology Flashcards by Rabia Dosani

What re the periapical tissues made up of?

The root of the teeth
The periodontal ligament space
The lamina dura
The alveolar bone

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How is the periodontal ligament seen on a radiograph?

Seen as a radiolucent line surrounding the roots the tooth

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Is the periodontal ligament a hard or soft tissue? What does this suggest about its radiographic presentation

It is a soft tissue so appears as a radiolucent line

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How is the Lamina dura represented on a radiographs

Seen as a radio opaque line next to the periodontal space

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Why is rthe lame dura sen as an opaque Lin eon. radiograph?

As it is made up of dense bone

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Describe how the periodontal ligament space would look on radiograph of a HEALTHY tooth

It would be of even with surrounding the entire tooth surface

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Describe how the Lamina dura would look on radiograph of a HEALTHY tooth

It would surround the entire root surface n an even width

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Which two characteristics do we comment on when describing bone?

The trabecular pattern

2. Density of bone

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Are the characteristics of the manual and maxillary bone the same?

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Describe the bone found in the mandible

Trabeculae is thick and horizontaly aligned

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Describe the bone found in the maxilla

trabeculae are finer and there’s no predominant pattern

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Describe the periapical tissues of deciduous teeth

1, 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

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What is one of the big problems when assessing periapical pathology on radiographs?

Superimposed shadows may be visible

these can be radiolucent or radio-opaque

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

Maxillary antrum
Nasopalatine foramen
Mental foramina

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Where does the Nasopalatine foramen

lie in the mouth?

Lies in the palette behind the upper central incisors

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Where does the mental foramen lie?

Lies inferior to the premolars in the mandible

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What effect do radiolucent superimposed shadows have on the presentation of the PDL on a radiograph?

The PDL may appear more radiolucent or widened but will still be continuous and well defined

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What effect do radiolucent superimposed shadows have on the presentation of the Lamina dura on a radiograph?

It may appear LESS obvious or to visible

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What effect do radiolucent superimposed shadows have on the presentation of the alveolar bone on a radiograph?

There may be a radiolucency in he alveolar bone at the apex of the tooth

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Give examples of some radio-opaque shadows that may be present on a periapical radiographs

Mylohyoid ridge
2 Body of the zygoma
Areas of sclerotic bone (dense bone islands)

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Does the Maxillary antrum appear as radiolucent or rai opaque on a radiograph? why?

Radiolucent
As it is filled with air
But the floor of the antrum appears as a curved radiopaque line

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What problems can the maxillary antrum present on a radiograph?

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

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

The soft tissue shadow of the nose

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

Appears s a curved radiodensty over the apices of the upper anterior teeth

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What can obscure the apices of the upper firstpre molars on. radiograph?

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 the apices of the lower teeth?

The mental foramen

How is the mental foramen represented on a radiograph?

It is superimposed on the lower fives

What can obscure the view of the apices of the lower wisdom teeth on a radiograph?

The ID canal and the external oblique ridge

How does the eternal oblique ridge appear on a radiograph?

Appears as a dense line of bone above the lower wisdom teeth

List the 5 cardinal sigs of inflammation following plural necrosis

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

Why does swelling occur after pupal necrosis

Due to the accumulation of inflammatory exudate in the apical PDL

What is the type of inflammatory response at the apex dependent on?

1, The infecting organism including its virulence | 2. The body defence system

We can not raiogrpahically differentiate an A_______ , G_____ or C______ from each other

Abscess Granuloma Cyst

Describe the radiographic presentation of initial acute inflammation

PDL may widen or there will 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

What can we ee radiographically if a patient has abscess

An ill defined radiolucency described as rarefying osteitis ,

Will an abscess always be seen on a radiograph?

NO it can take 10 days for digraphic appearances to catch up with symptoms

Describe the radiographic presentation further spreading of inflammation

Area of bone loss sen at Beth 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 en around the apex this is called Sclerosing osteitis

How might Sclerosing osteitis be seen on a radiograph?

1. May be no radiolucent component | 2. May be a halo of Sclerosing osteitis surrounding an area of rarefying osteitis

Where is Sclerosing osteitis often seen?

Often seen around the roots of lower first molars

What symptoms associated with Sclerosing osteitis?

Usually asymptomatic

What is another name for Sclerosing osteitis?

Condensing or focal Sclerosing osteitis

Name the two types of inflammatory Periapical pathology

1. Osteolytic | 2. Osteosclerotic

What does Osteolytic means?

Bone has been lost at the apex of the root

Is osteolytic inflammatory Periapical Pathology sen in acute of chronic inflammatory reactions

SEEn in both: | Relatively acute reactions and relatively chronic reactions

What does Osteosclerotic means?

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

Is Osteosclerotic inflammatory Periapical Pathology sen in acute of chronic inflammatory reactions

Only in chronic responses

Describe the radiographic presentation of later stages of chronic inflammation

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

What happens in later stages of chronic inflammation?

Apical bone isersorbed and destroyed and dense bone is laid down around the area of destruction Periapical granuloma or radicular cysts can also develop

How can you tell the difference between an apical granuloma and a radicular cyst?

If <1c, in diameter 2/3 are granulomas IF 1-1.5 in diameter could be either If >1.5cmm then 2/3 are cysts

Why is hard to differentiate between granulomas and radicular cysts?

As both are largely asymptomatic unless secondary infected | Both can be well define and be either corticated or uncortcated

Where does most inflammatory pathology manifest itself?

Manifests apically as this is the site of inflammatory exudate BUT can also manifest lateral to the root if there is a lateral canal or the root canal has been perforated

What is the only way to truly differentiate between an apical granuloma and radicular cyst?

By looking at histology

How may a sinus appear on a radiograph?

May be able to see a double dense shadow

What is the relationship between chronicity and radiolucency

As chronicity increases radiolucencies get more defined and re eventually corticated

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

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

What plural sclerosis?

Obliteration of the root canal

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

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

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

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

Give some factors that affect the diagnosis from a radiograph

1. Radiographic factors such as exposure 2. Percentage of bone loss 3. Erosion of cortex 4. Density of cancellous bone 5. Size of lesion 6. Age of lesion 7. Size of the pathology

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

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

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

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

Which technique is used to take radiographs for endodontic treatment?

We use endo ray holders

What may you still be Abe to see on a radiograph even f your pedodontic treatment was successful and why?

May still be able to a periapical radiolucency because: Healing may have occurred with fibrous tissue which ay leave residual radiolucency Surgical defect can increase radiolucency initially