DIFFERENTIAL DIAGNOSIS FOR PERIAPICAL RADIOLUCENCY.pptx

periapical pathosis

1. DIFFERENTIAL DIAGNOSIS OF PERI APICAL RADIOLUCENCIES

2. CLASSIFICATION TRUE FALSE TRUE PERIAPICAL RADIOLUCENCIES :- PULPOPERIAPICAL RADIOLUCENCIES DENTIGEROUS CYST PCOD PERIODONTAL DISEASE TRAUMATIC BONE CYST NON RADICULAR CYST MALIGNANT TUMORS

3. PSEUDO PERIAPICAL RADIOLUCENCIES:- ANATOMIC RADIOLUCENCIES

4. ANATOMIC RADIOLUCENCIES False periapical radiolucencies are produced by anatomic varients that do not contact the apex of the tooth. These radiolucencies may be shifted from the periapex by taking additional periapical radiographs at different angle. If radiolucencies are anatomic in origin,a comparision with the radiographs of the opposite side frequently reveals an identical situation.

5. MANDIBLE 1.Mandibular foramen 2.Mandibular canal 3.Mental foramen 4.Lingual foramen 5.Submandibular fossa 6.Mental fossa 7.Midline symphysis MAXILLA 1.Intermaxillary suture 2.Incisive foramen 3. Nasal fossa

6. APICAL PERIODONTITIS Apical periodontitis is the inflammation of the periodontal ligament around the root apex. It is of 2 types :- Acute Chronic

7. ACUTE APICAL PERIODONTITIS Definition: -Acute apical periodontitis is a painful inflammation of periodontium as a result of trauma, irritation [or] infection through root canal regardless of whether pulp is vital or non-vital. ETIOLOGY:- In a vital tooth: Occlusal trauma Wedging of foreign object b/w the teeth Blow to the teeth

8. In a non-vital tooth : As a sequlae to pulpitis Iotrogenic Forcing of medicaments Extension of obturating material Over instrumentation during cleaning & shaping

9. Clinical features pain Tooth is slightly elevated from the socket Tenderness on percussion Tooth may be slightly sore or may become sore on percussion Thermal changes does not induce pain .

10. RADIOGRAPHIC FEATURES Slight widening of PDL

11. DIFFERNTIAL DIAGNOSIS Acute alveolar abscess- Histologically Treatment :- Root canal treatment.

12. PERI APICAL GRANULOMA Most common type of pathologic radiolucency C/F :- Tooth is non vital It sounds dull on percussion due to granulation tissue at the apex. Pt complains of mild pain on chewing. R/F Well circumscribed rl surrounding apex Involved tooth may reveal deep rest`ns extensive caries. Swelling or expansion of cortical plates is unusual.

13. Differential diagnosis Radicular cyst :- Cyst is larger than granuloma but it is may not always right. If radiolucency is1.6cm or more it is more likely to be cyst. Surgical defects :-previous history should taken PCOD :- pulp is vital & frequently involves lower anteriors TRAUMATIC BONE CYST:- pulp vital, m ostly seen in lower posteriors,LD intact

14. TREATMENT ROOT CANAL TREATMENT EXTRACTION OF EFFCTED TOOTH

15. ABSCESS Abscess is an localised collection of pus surrounded by an area inflammed tissue in which hyperemia & infiltration of leucocytes is mark ETIOLOGY :- trauma chemical or mechanical irritation pulpal infection

16. ACUTE PERIAPICAL ABSCESS Clinical features :- Deep caries Pain & mobility discoloration fever & lymphadenopathy tender on percussion

17. CHRONIC PERIAPICAL ABSCESS CLINICAL FEATURES:- non-vital tooth pain may present swelling sinus opening vestibular tenderness tender on percussion

18. RADIOGRAPHIC FEATURES LOCATION:- present at the apex of involved tooth PHERIPHERY: -ill defined INTERNAL STRUCTURE:- radiolucent SURROUNDING STRUCTURES:- loss of LD in the peri apical region

19. DIFFERENTIAL DIAGNOSIS PERIODONTAL ABSCESS NON –ODONTOGENIC CYST

20. MANAGEMENT Analgesics Antibiotics Root canal treatment Extraction

21. PERI APICAL CYST CLINICAL FEATURES :- usually asymptomatic mostly seen in maxillary incisors if large produces swelling

22. RADIOGRAPHIC FEATURES LOCATION:- Presents at apex of tooth PHERIPHERY & SHAPE :- well defined pheriphery with cortical border, outline is curved or circular INTERNAL STRUCTURE :- Radiolucent EFFECT ON SURROUNDING STRUTURES:- If cyst is large,displacement & resorption of adjacent tooth may occur

23. DIFFERENTIAL DIAGNOSIS peri apical granuloma pcod traumatic bone cyst mandibular infected buccal cyst

24. MANAGEMENT ROOT CANAL THERAPY EXTRACTION FOR LARGE CYST WHERE BONE DESTROYED 1.surical ennucleation 2. surgical ennucleation & restoration of defect with graft 3. marsupilization Decompression 5.decompression with delayed ennucleation 6.creation of a common chamber with maxillary sinus or nasal cavity

25. PERI APICAL SCAR Peri apical scar is a dense fibrous tissue situated at the periapex of non vital tooth. Features :- well circumscribed radiolucency i.e., more or less round resembles granuloma/cyst & it is usually small. mostly in anterior of maxilla. rl remains constant in size/ shrink slightly.

26. 5.SURGICAL DEFECT It is an area that fails to fill in with osseous tissue after surgery. Seen periapically after root resection procedures when both labial & lingual plates have been destroyed . Mucosal scar due to previous surgery. R/F Usually round in app, smoothly contoured,well defined borders. Rl not more than 1cm in diameter . D/D SCAR

27. OSTEOMYELITIS Defined as inflammation of bone & marrow components. Streptococci, staphy.aureus, staphy.albus & anaerobes like bacteroides, prevotella. Predisposing factors:- Fractures due to trauma. Road traffic accidents. Gun shot wounds &Radiation damage Pagets disease & osteopetrosis Sys cond. Leukemia,malnutn,diabetes

28. Clinical features :- 30 to 80 yrs. Mostly seen in mandible. Tooth is non-vital may be associated with acute/chronic periapical abscess. Sinus is seen mucosa & skin.

29. RADIOGRAPHIC FEATURES LOCATION :-Post.body of mandible . Periphery & shape ;- Irregularly shaped with poor or ragged borders. Internal struc :- Radiolucent. Effect on surrounding struc :- LD lost. Can stimulate either resorption / formation of bone.

30. DIFFERENTIAL DIAGNOSIS CHRONIC ALVEOLAR ABSCESS EOSINOPHILIC GRANULOMA PAGETS DISEASE

31. HYPERPLASIA OF MAXILLARY SINUS LINING It appear as grey shadows that may be dome shaped in maxillary sinus floor Radicular cyst can pouch into the sinus & may show a thin curved radioopaque rim of bone seperating the cyst from the sinus cavity

32. DENTIGEROUS CYST It is an odontogenic cyst assosiated with crown of unerupted tooth CLINICAL FEATURES :- Clinical examination reveals a missing tooth & a hard swelling results in facial asymmetry

33. RADIOGRAPHIC FEATURES LOCATION :- Present above the crown of involved tooth PHERIPHERY: - Well defined INTERNAL STRUCTURE :- Radiolucent except for crown of unerupted SURROUNDING STRUCTURES :- Can displace & resorb the adjacent teeth

34. DIFFERENTIAL DIAGNOSIS HYPERPLASTIC FOLLICLE OKC CYSTIC AMELOBLASTOMA

35. MANAGEMENT Smaller lesions can surgically removed Larger lesions –insertion of surgical drain or marsupilization

36. PERIAPICAL CEMENTO OSSEOUS DYSPLASIA SYNONYMS :- Sclerosing cementum Periapical osteo fibrosis Fibrocementoma Periapical fibrosarcoma ETIOLOGY :- Trauma or Local irritation

37. CLINICAL FEATURES :- . Mostly present in mandibular anterior region . No history of pain/sensitivity . Occasionally lesion near the mental foramen and impinge on mental nerve & produces pain /parasthesia /even anaesthsia .Tooth have vital pulp

38. RADIOGRAPHIC FEATURES LOCATION : -Apex of the tooth PHERIPHERY : -Well defined INTERNAL STRUTURE :- Radiolucent surrounded by hyperostotic border Loss of lamina dura

39. DIFFERENTIAL DIAGNOSIS TRAUMATIC BONE CYST CEMENTOBLASTOMA MANAGEMENT :- Surgical ennucleation

40. TRAUMATIC BONE CYST SYNONYMS :- Solitory cone cyst Hemorrhagic cyst Extravasation cyst Unicameral bone cyst Simple bone cyst Idiopathic bone cyst ETIOLOGY :- Trauma

41. CLINICAL FEAATURES :- Mostly seen in young persons More male predilection Present mostly in posterior mandible Occasional tender on percussion

42. RADIOGRAPHIC FEATURES LOCATION :- mandible posterior part PHERIPHERY :- well defined delicate cortex to ill defined border that blends into surrrouding structure INTERNAL STRUCTURE :- total radiolucent SURROUNDING STRUTURE :- sometimes root resorption & displacement may present

43. DIFFERENTIAL DIAGNOSIS pcod radicular cyst median mandibular cyst

44. MANAGEMENT Conservative opening into the lesion & careful curettage of the lining this usually initiates the bleeding & subsequent healing

45. NON ODONTOGENIC CYST incisive canal cyst midpalatine cyst median mandibular cyst primordial cyst

46. Malignant tumours Squamous cell carcinoma Malignant tumors of minor salivary gland Osteolytic sarcoma Chondrosarcoma Melanoma Reticulum cell sarcoma Multiple myeloma

47. FEATURES :- More common in middle & old age May be pain Involve may retain their vitaliity Advance cases :-tooth migration, loosening , tipping, spreading Gingival bleeding may also present paresthesia/anesthesia of the soft tissues Expansion of jaw in advanced cases

48. RADIOGRAPHIC FEATURES Well defined or poorly defined radiolucency or a large ragged well defined radiolucent tumor Root resorption & band like widening of periodontal ligament space

49. MANAGEMENT :- Proper diagnosis has to be done to treat the affected tooth . Extensive management is recommended if microscopic study of periapical tissue after root resection is diagnosed as malignancy.

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