Radiographic Interpretation of Periapical Conditions

Question 1

2 other names for periapical inflammatory disease

Answer 1

Apical periodontitis
Periapical lesion

Question 2

3 types of periapical lesions

Answer 2

periapical abscess, granuloma and cyst

Question 3

Definition of periapical inflammatory disease

Answer 3

Inflammatory conditions of the apical periodontium of pulpal origin

Question 4

Periapical inflammatory disease can be __ or __, and __ or __

Answer 4

acute or chronic
symptomatic or asymptomatic

Question 5

What is needed for periapical inflammatory disease

Answer 5

Pulp necrosis

Question 6

Irreversible decomposition of the pulp

Answer 6

Pulp necrosis

Question 7

Destruction of the microvascular and lymphatic systems and ultimately, nerve fibers

Answer 7

Pulp necrosis

Question 8

The rigid dentin walls and lack of collateral circulation leads to inadequate drainage of inflammatory fluids –>

Answer 8

Increased pressure on the tissues and progressive destruction until the entire dental pulp is necrotized

Question 9

Pulp necrosis can result from __, __, or __ irritation of the pulp

Answer 9

bacterial
mechanical
chemical

Question 10

Pulp necrosis can not be determined __

Answer 10

radiographically

Question 11

What radiographic conditions can indicate that necrosis is likely present

Answer 11

deep restorations
caries lesions
fractures involving pulp

Question 12

When there is pulp necrosis what should be done

Answer 12

endodontic therapy

Question 13

What is the process of endodontic therapy to be done

Answer 13

Access
Removal of pulp tissues
Shaping, cleaning, and decontamination of canals (files and irrigating solutions)
Obturation (filling) of the decontaminated canals (gutta-percha)

Question 14

When there is pulp necrosis, bacteria and products of degradation can reach the __

Answer 14

Periapical tissues

Question 15

In a normal state there is a constant balance between
While in the presence of inflammation there is an

Answer 15

osteoblastic bone production and osteoclastic bone resorption
Inbalanace of these

Question 16

During inflammation and bone metabolism imbalance, which process is favored depends on these modulating factors

Answer 16

Microorganisms
Host immune response
Tissue vascularity
Time

Question 17

Sclerosing osteitis

Answer 17

When osteoblastic bone production is favored = sclerosis
osteitis = inflammation of the bone
(radiopaque / denser bone)

Question 18

Rarefying osteitis

Answer 18

When osteoclastic bone resorption is favored= Rarefaction
osteitis = inflammation of the bone
(radiolucent / less bone)

Question 19

1st sign of periapical disease

Answer 19

Widened PDL space

Question 19

What type of radiograph is best for periapical lesions

Answer 19

PA

Question 20

Periapical region of a tooth with compromised pulp (necrosis*)

Answer 20

Epicenter

Question 21

Radiolucency located at the inter-radicular bone is associated with an

Answer 21

accessory canal

Question 22

Radiolucencies located at the apex and inter-radicular alveolar bone (associated with accessory canal) is due to

Answer 22

recent endodontic treatment

Question 23

Pulp vitality test

Answer 23

Test to cold
Negative = pulp necrosis ( doesnt feel anything –> tooth is dead)
Positive = vital (not a periapical inflammatory disease or not its origin)

Question 24

__ or __ periapical inflammatory disease may show no radiographic signs

Answer 24

Early or acute

Question 25

Besides widening of the apical PDL space what is another radiographic sign of early periapical inflammatory disease

Answer 25

Loss of definition of lamina dura

Question 26

As lesion enlarge, bone __ is observed

Answer 26

rarefaction (radiolucent)

Question 27

Diffuse =

Answer 27

poorly defined (vs well defined)

Question 28

Abscess =
Granuloma =
Cyst =

Answer 28

more diffuse
well defined
well defined and corticated (>1 cm)

Question 29

Usually a long term effect of low grade infection/inflammation

Answer 29

Condensing osteitis / sclerosing osteitis (radiopaque)
- creates more bone to stop from spreading

Question 30

Is it common to have mixed radiolucent/radiopaque surrounding structures

Answer 30

Yes

Question 31

What can happen to the maxillary sinus with pulpal necrosis

Answer 31

regional mucositis within the maxillary sinus (inflammatory mediators stimulate the adjacent mucosal lining )

Question 32

Inflammatory reaction in the periapical region may trigger odontoclast activity leading to

Answer 32

root resorption

Question 33

Periapical inflammatory disease with deciduous molar can cause displacement of the developing premolar

Answer 33

disrupted eruption of underlying permanent teeth
Turner hyperplasia

Question 34

More widespread response to bone inflammation

Answer 34

osteomyelitis
(cancellous bone, cortical bone, periosteum)

Question 35

Acute vs chronic osteomyelitis

Answer 35

Acute = pain, swelling, fever, lymphadenopathy, leukocytosis, teeth mobility, sensitivity, drainage

Chronic = less severe symptoms but persistent

Question 36

Sequestrum is a result of

Answer 36

osteomyelitis

Question 37

Fragment of disease bone that have undergone necrosis as consequence of ischemic injury

Answer 37

sequestrum

Question 38

A periosteal reaction is a consequence of

Answer 38

osteomyelitis