Periapical Pathology Flashcards
What re the periapical tissues made up of?
- The root of the teeth
- 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 the tooth
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
How is the Lamina dura represented on a radiographs
Seen as a radio opaque line next to the periodontal space
Why is rthe lame dura sen as an opaque Lin eon. radiograph?
As it is made up of dense bone
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
Describe how the Lamina dura would look on radiograph of a HEALTHY tooth
It would surround the entire root surface n an even width
Which two characteristics do we comment on when describing bone?
- The trabecular pattern
2. Density of bone
Are the characteristics of the manual and maxillary bone the same?
NO
Describe the bone found in the mandible
Trabeculae is thick and horizontaly aligned
Describe the bone found in the maxilla
trabeculae are finer and there’s no predominant pattern
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
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
Give examples of some radiolucent shadows that may be present on a periapical radiographs
- Maxillary antrum
- Nasopalatine foramen
- Mental foramina
Where does the Nasopalatine foramen
lie in the mouth?
Lies in the palette behind the upper central incisors
Where does the mental foramen lie?
Lies inferior to the premolars in the mandible
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
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
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
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)
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
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
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 s a curved radiodensty over the apices of the upper anterior teeth
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
- Pain
- Loss of function
- Heat
- 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?
- 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
- 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
- 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
Give some factors that affect the diagnosis from a radiograph
- Radiographic factors such as exposure
- Percentage of bone loss
- Erosion of cortex
- Density of cancellous bone
- Size of lesion
- Age of lesion
- Size of the pathology
What type of radiographs do you need before carrying our Endodontic treatment
- A good quality preoperative paralleling periapical
- One good quality paralleling periapical to deter the working length
- 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
