Periapical Pathosis/Osteonecrosis

Question 1

Accumulation of acute inflammatory cells at apex of a non-vital tooth

Answer 1

Periapical abscess

Question 2

Can be symptomatic or asymptomatic

Becomes symptomatic as the purulent material accumulates within the alveolus

Affected tooth does not respond to EPT or cold test

Headache, malaise, fever and chills may be present

Answer 2

Periapical Abscess

Question 3

What is the radiographic presentation of periapical abscess?

Answer 3

thickening of the apical periodontal ligament or an ill-defined radiolucency

Question 4

If the purulent material of a periapical abscess extends through the meduallary spaces away from the apical area is can result in?

Answer 4

osteomyelitis

Question 5

If the purulent material of a periapical abscess perforates the cortex and spreads through overlying soft tissue it causes?

Answer 5

Cellulitis

Question 6

Bone sclerosis at the apex of teeth with pulpitis/pulp necrosis

Seen at the apex of teeth with large carious lesion or large restoration

Rx: localized uniform area of radiodensity at the apex of the tooth

Mostly involves MD molars and premolars

Answer 6

Condensing Osteitis

Question 7

A mass of chronically inflamed or subacutely inflamed granulation tissue at the apex of a non vital tooth

Represents a defensive ration to the presence of microbial infection in the root canal and spread of toxic products into the apical zone

Answer 7

Periapical Granuloma

Question 8

Occurs when an acute inflammatory process spreads through the medullary spaces of the bone.

signs and symptoms of an acute inflammatory process are present

Drainage, exfoliation of sequestrum or involucrum formation can occur

Rx - unremarkable or ill-defined radiolucency

Answer 8

Acute suppurative osteomyelitis

Question 9

occurs when defensive response leads to the production of granulation tissue with subsequent formation of dense scar

develops after a month of the acute process and difficult to manage unless treated aggressively

swelling, pain, purulent discharge, sequestrum formation

Rx - patchy ragged ill-defined radiolucency that often contains central radiopaque sequestra

Answer 9

Chronic suppurative osteomyelitis

Question 10

A periosteal reaction to the presence of inflammation

Most common cause is dental caries associated with periapical inflammatory disease

Common in children and young adults

MD premolar, molar area

Rx - parallel radiopaque laminations of bone overlying the cortical surface

Answer 10

Proliferative periosteitis

Question 11

A true epithelium lined cyst formed by stimulation of the epithelium at the apex of a non vital tooth

typically asymptomatic unless acutely inflamed

Answer 11

Periapical cyst

Question 12

A periapical cyst that is not removed at the time of extraction of the tooth

Appears as a persistent round to oval radiolucency at the site of previous tooth extraction

Answer 12

Residual cyst

Question 13

Occurs when the bone defect created by periapical lesion heals by formation of dense collagenous tissue instead of forming normal bone

Occurs when both the buccal and lingual cortical plates have been lost

Answer 13

Periapical scar

Question 14

Unique pattern of pulpal inflammation

Large pulp exposure

occurs in children/young adults

typically involves deciduous or permanent molars

Answer 14

Chronic hyperplastic pulpitis (pulp polyp)

Question 15

Caused by the use of medications that inhibit osteoclastic resorption of bone and used in the management of metabolic bone disease, metastatic disease and malignancy.

Mandibular predominance

Answer 15

Bisphosphonate associated osteonecrosis