Apical peridontal cyst, Periapical abscess.pptx

Dental UG

1. Apical Periodontal cyst, Periapical abscess Dr Soumya Anandan SRDC Diseases of microbial origin Synopsis Diseases of periapical tissues Apical Periodontal cyst, Periapical abscess Introduction, Clinical Features, Radiological Features Histological features, Treatment and Prognosis of APC Introduction, Clinical Features, Radiological Features Histological features, Treatment and Prognosis of Periapical abscess

2. Diseases of Periapical infection Dr Soumya Anandan SRDC Diseases of microbial origin

3. Apical Periodontal cyst- Introduction Dr Soumya Anandan SRDC Diseases of microbial origin Other name: Radicular cyst APC most common odontogenic cyst Sequala of periapical granuloma Result of bacterial infection and necrosis of the dental pulp It is a true cyst, since the lesion consists of a pathologic cavity that is lined by epithelium and is often fluid-filled.

4. Apical Periodontal cyst- Causes Dr Soumya Anandan SRDC Diseases of microbial origin The epithelial lining is derived from the epithelial rests of Malassez, which proliferate as a result of the inflammatory stimulus in a pre-existing granuloma. As pointed out in the section on the periapical granuloma, the epithelium may be derived in some cases from: Respiratory epithelium of the maxillary sinus when the periapical lesion communicates with the sinus wall Oral epithelium from a fistulous tract Oral epithelium proliferating apically from a periodontal pocket.

5. Apical Periodontal cyst- Clinical features Dr Soumya Anandan SRDC Diseases of microbial origin

6. Apical Periodontal cyst- Clinical features Dr Soumya Anandan SRDC Diseases of microbial origin

7. Apical Periodontal cyst- Pathogenesis Dr Soumya Anandan SRDC Diseases of microbial origin

8. Apical Periodontal cyst- Pathogenesis Dr Soumya Anandan SRDC Diseases of microbial origin

9. Apical Periodontal cyst- Clinical features Dr Soumya Anandan SRDC Diseases of microbial origin Asymptomatic Age: 20-60years Co mmon tooth: Maxillary anteriors Associated non- vital tooth or deep caries S eldom painful or even sensitive to percussion. C yst is only infrequently of such a size that it destroys much bone, P roduce expansion of the cortical plates rarely. Chronic process M ay undergo an acute exacerbation and develop rapidly into an abscess that may then proceed to a cellulitis or form a draining fistula.

10. Apical Periodontal cyst- Radiological features Dr Soumya Anandan SRDC Diseases of microbial origin A pical periodontal c yst thin, radiopaque line around the periphery of the radiolucent area, and this indicates a reaction of the bone to the slowly expanding mass.

11. Apical Periodontal cyst- Histopathology features Dr Soumya Anandan SRDC Diseases of microbial origin Identical to periapical granuloma, except for the presence of the epithelium-lined lumen. The epithelium lining the apical periodontal cyst is usually stratified squamous in type. Presence of hyaline bodies: tiny linear or arc-shaped bodies. Connective tissue stroma is highly inflamed with a plenty of fibroblasts and blood vessels. Dystrophic calcifications and collections of cholesterol slits are seen - shimmering effect

12. Apical Periodontal cyst- Histopathology features Dr Soumya Anandan SRDC Diseases of microbial origin

13. Apical Periodontal cyst- Histopathology features Dr Soumya Anandan SRDC Diseases of microbial origin

14. Apical Periodontal cyst- Histopathology features Dr Soumya Anandan SRDC Diseases of microbial origin

15. Apical Periodontal cyst- Treatment and Prognosis Dr Soumya Anandan SRDC Diseases of microbial origin Removal of the tooth and curettage larger the cyst, Prognosis is worst, particularly the periapical cyst. Untreated- Bone expansion Epidermoid carcinoma may arise if untreated (from the lining)

16. Periapical Abscess- Introduction Dr Soumya Anandan SRDC Diseases of microbial origin Other name: Dentoalveolar abscess, alveolar abscess A cute or chronic suppurative process of the dental periapical region. It may develop either from acute periapical periodontitis or more commonly from a periapical granuloma. Acute exacerbation of a chronic periapical lesion is known as Phoenix abscess . (Result of infection, trauma) leading to necrosis of pulp. It is a mixed infection with the culture of pus yielding to a wide range of different bacterial species.

17. Periapical Abscess- Clinical Features Dr Soumya Anandan SRDC Diseases of microbial origin Features Acute Periapical Abscess Chronic Periapical Abscess Initial Stages Tenderness relived by pressure No C/f Progressive stage Severe pain and tooth extrusion from the pocket. Regional lymphadenitis and fever may be present Mild, well-circumscribed area of suppuration that shows little tendency to spread from the local area

18. Periapical Abscess- Clinical Features Dr Soumya Anandan SRDC Diseases of microbial origin

19. Periapical Abscess- Radiological features Dr Soumya Anandan SRDC Diseases of microbial origin Periodontal space widening and ill defined radiolucency .

20. Periapical Abscess- Histopathology features Dr Soumya Anandan SRDC Diseases of microbial origin There is central area of disintegrating polymorphonuclear leukocytes surrounded by viable leukocytes, occasional lymphocytes, cellular debris, necrotic materials and bacterial colonies. There is dilatation of the blood vessels in the periodontal ligament and adjacent marrow spaces of the bone. These marrow spaces also show an inflammatory cell infiltrate. The tissue around the area of suppuration contains a serous exudate.

21. Periapical Abscess - Histopathology features Dr Soumya Anandan SRDC Diseases of microbial origin

22. Apical Periodontal cyst- Treatment and Prognosis Dr Soumya Anandan SRDC Diseases of microbial origin Incision and Drainage Antibiotic therapy If the periapical abscess is not treated, it may lead to serious complications through the spread of the infection. These include osteomyelitis, cellulitis, and bacteremia, fistulous tract opening on the oral mucosa . Cavernous sinus thrombosis has also been reported.