PERIAPICAL DISEASES

PERIAPICAL DISEASES AND ITS MANAGEMENT...

1. PERIAPICAL DISEASES

2. CLASSIFICATION Symptomatic periradicular diseases a)symptomatic apical periodontitis i ) vital tooth ii) non vital tooth b)Acute alveolar abscess c)Phoenix abscess External root resorption Persistent apical periodontitis

3. Asymptomatic periradicular diseases a)Asymptomatic apical periodontitis b)Chronic alveolar abscess c)condensing osteitis

4. ACUTE APICAL PERIDONTITIS: DEFINITION : Symptomatic apical periodontitis is a painful inflammation of the periodontism as a result of trauma, irritation, or infection through the root canal, regardless of whether the pulp is vital or non-vital , producing clinical symptoms including painful response to biting and percussion. CAUSES: In vital tooth -abnormal occlusal contacts -inserted restoration extending beyond the occlusal plane -wedging of a foreign object between the tooth

5. In non-vital tooth - sequelae of pulpal diseases -Iatrogenic causes SYMPTOMS: -Pain and tenderness of the tooth -Patient may have pain on closure and mastication DIAGNOSIS: -Pain on percussion.

6. RADIOGRAPHIC CHANGES: -Non vital tooth : Widening of apical periodontal ligament and loss of lamina dura . -Vital tooth : No radiographic changes . TREATMENT : -Determining the cause and reliving the symptoms .

7. ACUTE ALVEOLAR ABSCESS: DEFINITION: An acute alveolar abscess is an inflammatory reaction to pulpal infection and necrosis characterised by rapid onset , spontaneous pain , tenderness of tooth to pressure , pus formation and eventual swelling of associated tissues . CAUSES : Trauma or chemical or mechanical irritation , the immediate cause is generally bacterial invasion of dead pulp tissue .

8. SYMPTOMS: -Tenderness of the tooth that may be relived by continued slight pressure on the extruded tooth to push it back into the alveolus . -Intra oral or extra oral swelling tender on palpation . -

9. -Patient may complaint of fever and malaise. -Patient may appear pale , irritable and weakened from pain and loss of sleep. -Slight raise in temperature . DIAGNOSIS : -Clinical examination -Electric pulp test and thermal test .

10. RADIOGRAPHIC FEATURES : Widening of periodontal ligament and loss of lamina dura . TREATMENT : Drainage and controlling systemic reaction .

11. PHOENIX ABSCESS: DEFINITION: This condition is an acute inflammatory reaction superimposed on an existing asymptomatic apical periodontitis . CAUSES: - Noxious stimulus from the diseased pulp can cause acute inflammatory response . - Lowering of body defences due to the influx from the root canal. SYMPTOMS: - Inflammation progresses, the tooth gets elevated from its socket and becomes sensitive.

12. -The mucosa over the radicular area may appear red and swollen. RADIOGRAPHIC CHANGES: Well-defined periradicular lesions Widening of the periodontal ligament spaces

13. DIAGNOSIS: -Lack of response to vitality tests diagnosis a necrotic pulp. -On rare occasions, a tooth may response -discoloration of the tooth. -To the electric pulp test because fluid in the root canal. TREATMENT: Drainage and controlling the systemic reaction.

14. CHRONIC APICAL PERIODONTITIS: DEFINITION: Asymptomatic apical periodontitis is the symptomless sequelae of symptomatic apical periodontitis and is characterized radiographically by periradicular radiolucent changes and histologically by the lesion dominated with macrophages, lymphocytes, and plasma cells. SYMPTOMS: -May not produce any subjective reaction.

15. DIAGNOSIS: RADIOGRAPHIC FEATURES: - area of rarefaction is well-defined with lack of continuity of the lamina dura - tooth does not respond to thermal or electric pulp tests. TREATMENT: Root canal therapy

16. CHRONIC ALVEOLAR ABSCESS: DEFINITION: A chronic alveolar abscess is a long-standing, low grade infection of the periradicular alveolar bone generally symptomless and characterized by the presence of abscess draining through the sinus tract. CAUSES: Natural sequelae of death of pulp with extension of the infective process periapically . SYMPTOMS: Asymptomatic

17. RADIOGRAPHIC FEATURES: Discontinuity of the lamina dura at the periapex or ill-defined periapical radiolucency . TREATMENT: Elimination of the infection in the root canal.

18. RADICULAR CYST: DEFINITION: A cyst is a closed cavity or sac internally with fluid or semisolid material. SIGNS AND SYMPTOMS: patient may complaint of dull aching pain or may be asymptomatic CLINICAL FINDINGS: tooth involved shows a deep carious lesion, tender or non-tender on percussion . diffuse expansion of the cortical plates.The affected site may reveal a well-defined bony hard swelling.

19. RADIOGRAPHIC FEATURES: Well-defined radiolucency measuring >1.5cm in diameter at the periapex of the tooth surrounded by a sclerotic border TREATMENT: Surgical Enucleation

20. CONDENSING OSTEITIS: DEFINITION Condensing osteitis is adiffuse radiopaque lesion believed to represent a localized bony reaction to a low-grade inflammatory stimulus, usually seen at the apex of a tppth in which there has been a long-standing pulpal pathosis . CAUSES: Condensing osteitis is a mild irritation from pulpal disease that stimulates osteblastic activity in the alveolar bone

21. SYMPTOMS: Asymptomatic It is discovered during routine radiographic examination DIAGNOSIS: Osteitis appears in radiographs as a localized area of radiopacity surrounding the affected root. It is an area of dense bone with reduced trabecular pattern

22. EXTERNAL ROOT RESORPTION External surface root resorption Etiology Luxtation injury to PDL , Traumatic occlusion Orthodontic treatment Clinical feature asymptomatic ,mobility in short roots Radiograhic feature Negative

23. Treatment Elimination of trauma ,no endodontic treatmernt required. External inflammation root resorption Etiology Long standing periradicular lesion Abnormnal pressure Clinical feature Increased mobility , extruded occasionally , presence of sinus tract

24. Radiographic feature Progressive cavitation involving root and alveolus bone at 2-4 week Treatment Mature teeth - shaping & cleaning & use of caOH2 medicament for 2-4week followed by obturation Immature teeth - Caution regarding the use of caHO2 for prolonged duration due to its weakeing effect on the tooth . MTA apexification is a valuable alternative

25. External replacement root resorption Etiology Intrusion & reimplantation of avulsed tooth Clinical feature Metallic sound on percussion Radiographic feature Root structure is replaced by bone

26. Internal root resorption Etiology Trauma , crown preparation , pulpotomy , Inflammed pulp Clinical feature Asymptomatic until the inflammatory process communicate with the external tooth surface . Radiographic feature Root canal outline distorted & radiolucent defect appear continuous , Does not involve bone