Pulpal and PA pathology lucencies Flashcards
Pulpal Interpretation factors
Size
Secondary dentin
Pulp stones, Pulpal sclerosis
Internal/External resorption
enlarged pulp chamber, young pt
enlarged pulp chambers, young pts
Small Pulp Chamber/Secondary Dentin Formation: Older Patient
compare with contralateral tooth
Enlarged Pulp Chamber/Root Canal: Non-vital tooth #7.
Compare with contralateral tooth.
Secondary Dentin Formation/Pulpal Recession –
Distal Pulp Horn of First Molar
pulp stones
pulp stones
pulpal sclerosis
internal root resorption
internal root resorb
External Root Resorption
External Root Resorption from tumor
External Root Resorption from impacted mesiodens that is resorbing
large horns/chamber issues
potential for carious exposure
ext root resorb, due to inflammatory process, may req endo
secondary dentin formation can make pulp chamber app as if its gone
Potential Superimposition of Normal
Anatomic Structures
Nasopalatine foramen
Lateral fossa
Mental foramen
8/9 luceny, pathologic?
no, NP canal
lateral fossa
internal root resorb
internal would be seen in canal system as aneurysm
int root resorb tx
endo
ext root resorb
not due to pulpal inflamm, ext pressure resorbing tooth (ortho, tumor, etc.)
mental foramen
Open apices in young patient
simulates periapical lesion.
lamina dura importance
follow around the root to ensure lucency is not pathologic but instead anatomic
Periapical Radiolucencies
Periapical Abscess
Periapical Granuloma
Periapical Cyst
Residual/Recurrent Cyst
Periapical Cemento-Osseous Dysplasia
Fibrous Healing Defect
Acute Pulpal/Periapical Diseases
Reversible/irreversible pulpitis
Acute apical abscess
reversiable pulpitis/early irreversable radio
may be none, use clinical findings
Apical Abscess Radiographic Findings at Apex
in sequential order
1. PDL space thickening
1. Discontinuity of lamina dura
1. Periapical radiolucency
1st molar path
Periodontal ligament space widening at mesial apex of first molar.
discontinuous LD on 1st molar
what could this be in an acute case
abcess
Chronic Periapical Inflammatory Lesions
Chronic apical abscess
Periapical granuloma
Periapical cyst
Periapical rarefying osteitis (umbrella term)
can we dif abcesses, granulomas and cyst radiographically?
no
chronic apical abcess radio
small luceny surrounded by sclerotic bone
apical diagnosis
CAA
CAA
PA granuloma radio
variable: well or ill defined margins, thin sclerotic border or not
PA cyst may develop from
granuloma
PA cyst radio
well defined often with thin sclerotic border (corticated)
PA cyst
granuloma vs cyst differentiation by size?
not done, but the larger the more likely it is a cyst
Residual Cyst vs.
Recurrent Cyst
residual: remain after tooth has been extracted/lost
recurrent: removed tooth with no cyst, later on a cyst develops in this area due to remanent epithelium
CAA divisions
those with and without DST (draining fistula with parulis)
CAA, what is seen D?
DST
Gutta Percha Point to Identify
Source of Draining Fistula
Periapical Halo Formation
corticated border around apex of the tooth, none of it will contact part of the tooth
due to the tooth developing abcess in which fluid penetrated into sinus>periosteum stimulated to form layer of bone
PA halo formation
apical scars
occurs with tx of PA pathologies, may be small luceny associated with PT teeth
apical scar diagnosis
would need prior radiographs to confirm, luceny would not change overtime
fibrous healing defect
large PA lesion destroying B/L cortexes: not able tp reform bone
very radiolucent, no sclerotic border, no change over time
fibrous healing defect
PERIAPICAL
CEMENTO-OSSEOUS DYSPLASIA
three stages, beings as lucency then filled in with opacities
early stage can resemble inflam lesion due to lucencies
no tx required
PA cemento-osseous dyplasia
metastic carcinoma at apices
irregular, ill defined borders with isolated trabeculae
