Radiographic Interpretation of Periapical Conditions Flashcards
2 other names for periapical inflammatory disease
Apical periodontitis
Periapical lesion
3 types of periapical lesions
periapical abscess, granuloma and cyst
Definition of periapical inflammatory disease
Inflammatory conditions of the apical periodontium of pulpal origin
Periapical inflammatory disease can be __ or __, and __ or __
acute or chronic
symptomatic or asymptomatic
What is needed for periapical inflammatory disease
Pulp necrosis
Irreversible decomposition of the pulp
Pulp necrosis
Destruction of the microvascular and lymphatic systems and ultimately, nerve fibers
Pulp necrosis
The rigid dentin walls and lack of collateral circulation leads to inadequate drainage of inflammatory fluids –>
Increased pressure on the tissues and progressive destruction until the entire dental pulp is necrotized
Pulp necrosis can result from __, __, or __ irritation of the pulp
bacterial
mechanical
chemical
Pulp necrosis can not be determined __
radiographically
What radiographic conditions can indicate that necrosis is likely present
deep restorations
caries lesions
fractures involving pulp
When there is pulp necrosis what should be done
endodontic therapy
What is the process of endodontic therapy to be done
Access
Removal of pulp tissues
Shaping, cleaning, and decontamination of canals (files and irrigating solutions)
Obturation (filling) of the decontaminated canals (gutta-percha)
When there is pulp necrosis, bacteria and products of degradation can reach the __
Periapical tissues
In a normal state there is a constant balance between
While in the presence of inflammation there is an
osteoblastic bone production and osteoclastic bone resorption
Inbalanace of these
During inflammation and bone metabolism imbalance, which process is favored depends on these modulating factors
Microorganisms
Host immune response
Tissue vascularity
Time
Sclerosing osteitis
When osteoblastic bone production is favored = sclerosis
osteitis = inflammation of the bone
(radiopaque / denser bone)
Rarefying osteitis
When osteoclastic bone resorption is favored= Rarefaction
osteitis = inflammation of the bone
(radiolucent / less bone)
1st sign of periapical disease
Widened PDL space
What type of radiograph is best for periapical lesions
PA
Periapical region of a tooth with compromised pulp (necrosis*)
Epicenter
Radiolucency located at the inter-radicular bone is associated with an
accessory canal
Radiolucencies located at the apex and inter-radicular alveolar bone (associated with accessory canal) is due to
recent endodontic treatment
Pulp vitality test
Test to cold
Negative = pulp necrosis ( doesnt feel anything –> tooth is dead)
Positive = vital (not a periapical inflammatory disease or not its origin)
__ or __ periapical inflammatory disease may show no radiographic signs
Early or acute
Besides widening of the apical PDL space what is another radiographic sign of early periapical inflammatory disease
Loss of definition of lamina dura
As lesion enlarge, bone __ is observed
rarefaction (radiolucent)
Diffuse =
poorly defined (vs well defined)
Abscess =
Granuloma =
Cyst =
more diffuse
well defined
well defined and corticated (>1 cm)
Usually a long term effect of low grade infection/inflammation
Condensing osteitis / sclerosing osteitis (radiopaque)
- creates more bone to stop from spreading
Is it common to have mixed radiolucent/radiopaque surrounding structures
Yes
What can happen to the maxillary sinus with pulpal necrosis
regional mucositis within the maxillary sinus (inflammatory mediators stimulate the adjacent mucosal lining )
Inflammatory reaction in the periapical region may trigger odontoclast activity leading to
root resorption
Periapical inflammatory disease with deciduous molar can cause displacement of the developing premolar
disrupted eruption of underlying permanent teeth
Turner hyperplasia
More widespread response to bone inflammation
osteomyelitis
(cancellous bone, cortical bone, periosteum)
Acute vs chronic osteomyelitis
Acute = pain, swelling, fever, lymphadenopathy, leukocytosis, teeth mobility, sensitivity, drainage
Chronic = less severe symptoms but persistent
Sequestrum is a result of
osteomyelitis
Fragment of disease bone that have undergone necrosis as consequence of ischemic injury
sequestrum
A periosteal reaction is a consequence of
osteomyelitis
