dr. győrfi adrienne - semmelweis egyetem | kutató...
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![Page 1: Dr. Győrfi Adrienne - Semmelweis Egyetem | Kutató ...semmelweis.hu/konzervalo-fogaszat/files/2015/11/Peri...Irritative factors 1. Microbial irritants: Streptococci, Lactobacilli,](https://reader031.vdocuments.net/reader031/viewer/2022021502/5aee886d7f8b9ac57a8c1dbe/html5/thumbnails/1.jpg)
Periapical diseases Dr. Győrfi Adrienne
![Page 2: Dr. Győrfi Adrienne - Semmelweis Egyetem | Kutató ...semmelweis.hu/konzervalo-fogaszat/files/2015/11/Peri...Irritative factors 1. Microbial irritants: Streptococci, Lactobacilli,](https://reader031.vdocuments.net/reader031/viewer/2022021502/5aee886d7f8b9ac57a8c1dbe/html5/thumbnails/2.jpg)
Irritative factors
1. Microbial irritants: Streptococci,
Lactobacilli,
Actinomyces viscosus
2. Mechanical irritants: inadequate cooling during
cavity or crown preparation,
trauma or orthodontic
movement, deep scaling
and curettage
3. Chemical irritants: alcohol, chloroform,
hydrogen peroxide,
acid etching,
overfilled root canal!!!!
![Page 3: Dr. Győrfi Adrienne - Semmelweis Egyetem | Kutató ...semmelweis.hu/konzervalo-fogaszat/files/2015/11/Peri...Irritative factors 1. Microbial irritants: Streptococci, Lactobacilli,](https://reader031.vdocuments.net/reader031/viewer/2022021502/5aee886d7f8b9ac57a8c1dbe/html5/thumbnails/3.jpg)
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Classification of periapical
diseases
1. Acute apical periodontitis
2. Chronic apical periodontitis
3. Condensing osteitis
4. Acute apical abscess
5. Chronic apical abscess
(Suppurative apical periodontitis)
![Page 5: Dr. Győrfi Adrienne - Semmelweis Egyetem | Kutató ...semmelweis.hu/konzervalo-fogaszat/files/2015/11/Peri...Irritative factors 1. Microbial irritants: Streptococci, Lactobacilli,](https://reader031.vdocuments.net/reader031/viewer/2022021502/5aee886d7f8b9ac57a8c1dbe/html5/thumbnails/5.jpg)
1. Acute apical periodontitis
Etiology: extension of pulpal inflammation into periapical tissue, endodontic treatment
Symptoms: excruciating pain uppon contact of opposing teeth
if sequal irreversible pulpitis: symptoms of irreversible pulpitis
if result of necrosis: symptoms of necrosis
Vitality test: no respond to vitality tests
Radiograph: depending on how long time was the process: normal or thickening of periodontal ligament space
Histology: PMN leukocytes, macrophages; bone and root
resorption
Treatment: release of periapical exudate and root canal
therapy, to close!!!!
![Page 6: Dr. Győrfi Adrienne - Semmelweis Egyetem | Kutató ...semmelweis.hu/konzervalo-fogaszat/files/2015/11/Peri...Irritative factors 1. Microbial irritants: Streptococci, Lactobacilli,](https://reader031.vdocuments.net/reader031/viewer/2022021502/5aee886d7f8b9ac57a8c1dbe/html5/thumbnails/6.jpg)
Acute apical periodontitis
![Page 7: Dr. Győrfi Adrienne - Semmelweis Egyetem | Kutató ...semmelweis.hu/konzervalo-fogaszat/files/2015/11/Peri...Irritative factors 1. Microbial irritants: Streptococci, Lactobacilli,](https://reader031.vdocuments.net/reader031/viewer/2022021502/5aee886d7f8b9ac57a8c1dbe/html5/thumbnails/7.jpg)
1. Acute apical periodontitis
Etiology: extension of pulpal inflammation into periapical tissue, endodontic treatment
Symptoms: excruciating pain uppon contact of opposing teeth
if sequal irreversible pulpitis: symptoms of irreversible pulpitis
if result of necrosis: symptoms of necrosis
Vitality test: no respond to vitality tests
Radiograph: depending on how long time was the process: normal or thickening of periodontal ligament space
Histology: PMN leukocytes, macrophages; bone and root
resorption
Treatment: release of periapical exudate and root canal
therapy, to close!!!!
![Page 8: Dr. Győrfi Adrienne - Semmelweis Egyetem | Kutató ...semmelweis.hu/konzervalo-fogaszat/files/2015/11/Peri...Irritative factors 1. Microbial irritants: Streptococci, Lactobacilli,](https://reader031.vdocuments.net/reader031/viewer/2022021502/5aee886d7f8b9ac57a8c1dbe/html5/thumbnails/8.jpg)
2. Chronic apical periodontitis
Etiology: pulp necrosis, acute apical periodontitis
Symptoms: asymptomatic, or slight discomfort,
slight percussion sensitivity
Vitality test: no respond to vitality tests
Radiograph: destruction of periapical tissues
Hystology: periapical granuloma: granulomatous
tissue, macrophages, histiocytes,
plasma cells
apical cysts: the central cavity filled with
eosinophilic fluid, connective tissue, the
caracteristics cells of the granuloma
Treatment: root canal therapy
![Page 9: Dr. Győrfi Adrienne - Semmelweis Egyetem | Kutató ...semmelweis.hu/konzervalo-fogaszat/files/2015/11/Peri...Irritative factors 1. Microbial irritants: Streptococci, Lactobacilli,](https://reader031.vdocuments.net/reader031/viewer/2022021502/5aee886d7f8b9ac57a8c1dbe/html5/thumbnails/9.jpg)
Chronic apical
periodontitis
(granuloma)
Chronic apical
periodontitis
(cyst)
![Page 10: Dr. Győrfi Adrienne - Semmelweis Egyetem | Kutató ...semmelweis.hu/konzervalo-fogaszat/files/2015/11/Peri...Irritative factors 1. Microbial irritants: Streptococci, Lactobacilli,](https://reader031.vdocuments.net/reader031/viewer/2022021502/5aee886d7f8b9ac57a8c1dbe/html5/thumbnails/10.jpg)
2. Chronic apical periodontitis
Etiology: pulp necrosis, acute apical periodontitis
Symptoms: asymptomatic, or slight discomfort,
slight percussion sensitivity
Vitality test: no respond to vitality tests
Radiograph: destruction of periapical tissues
Hystology: periapical granuloma: granulomatous
tissue, macrophages, histiocytes,
plasma cells
apical cyst: the central cavity filled with
eosinophilic fluid, connective tissue, the
caracteristics cells of the granuloma
Treatment: root canal therapy
![Page 11: Dr. Győrfi Adrienne - Semmelweis Egyetem | Kutató ...semmelweis.hu/konzervalo-fogaszat/files/2015/11/Peri...Irritative factors 1. Microbial irritants: Streptococci, Lactobacilli,](https://reader031.vdocuments.net/reader031/viewer/2022021502/5aee886d7f8b9ac57a8c1dbe/html5/thumbnails/11.jpg)
3. Condensing osteitis
Etiology: the irritants diffus from the root canal into periapical tissue (pulp necrosis, pulpitis)
Symptoms: discomfort or pain
Vitality test: may not or may respond to thermal or
electrical stimuli
Radiograph: diffuse concentric radiopacity around
the root of the tooth
Hystology: irregularly arrenged trabecular bone
Treatment: root canal therapy
![Page 12: Dr. Győrfi Adrienne - Semmelweis Egyetem | Kutató ...semmelweis.hu/konzervalo-fogaszat/files/2015/11/Peri...Irritative factors 1. Microbial irritants: Streptococci, Lactobacilli,](https://reader031.vdocuments.net/reader031/viewer/2022021502/5aee886d7f8b9ac57a8c1dbe/html5/thumbnails/12.jpg)
Condensing osteitis
![Page 13: Dr. Győrfi Adrienne - Semmelweis Egyetem | Kutató ...semmelweis.hu/konzervalo-fogaszat/files/2015/11/Peri...Irritative factors 1. Microbial irritants: Streptococci, Lactobacilli,](https://reader031.vdocuments.net/reader031/viewer/2022021502/5aee886d7f8b9ac57a8c1dbe/html5/thumbnails/13.jpg)
3. Condensing osteitis
Etiology: the irritants diffus from the root canal into periapical tissue (pulp necrosis, pulpitis)
Symptoms: discomfort or pain
Vitality test: may not or may respond to thermal or
electrical stimuli
Radiograph: diffuse concentric radiopacity around
the root of the tooth
Hystology: irregularly arrenged trabecular bone
Treatment: root canal therapy
![Page 14: Dr. Győrfi Adrienne - Semmelweis Egyetem | Kutató ...semmelweis.hu/konzervalo-fogaszat/files/2015/11/Peri...Irritative factors 1. Microbial irritants: Streptococci, Lactobacilli,](https://reader031.vdocuments.net/reader031/viewer/2022021502/5aee886d7f8b9ac57a8c1dbe/html5/thumbnails/14.jpg)
4. Acute apical abscess
Etiology: is a localised and severe inflammatory response
(pulp necrosis)
Symptoms: pain, swelling, systemic maniestations (fever,
malaise, leukocytosis)
Vitality test: no response to thermal or electrical stimuli,
pain on percussion!!!!
Radiograph: thickening of the periodontal ligament space,
frank periapical lesion
Hystology: liquefaction necrosis, PMN leukocytes,
granulomatous tissue
Treatment: drainage, root canal therapy, to close!!!
![Page 15: Dr. Győrfi Adrienne - Semmelweis Egyetem | Kutató ...semmelweis.hu/konzervalo-fogaszat/files/2015/11/Peri...Irritative factors 1. Microbial irritants: Streptococci, Lactobacilli,](https://reader031.vdocuments.net/reader031/viewer/2022021502/5aee886d7f8b9ac57a8c1dbe/html5/thumbnails/15.jpg)
Acute apical abscess
![Page 16: Dr. Győrfi Adrienne - Semmelweis Egyetem | Kutató ...semmelweis.hu/konzervalo-fogaszat/files/2015/11/Peri...Irritative factors 1. Microbial irritants: Streptococci, Lactobacilli,](https://reader031.vdocuments.net/reader031/viewer/2022021502/5aee886d7f8b9ac57a8c1dbe/html5/thumbnails/16.jpg)
![Page 17: Dr. Győrfi Adrienne - Semmelweis Egyetem | Kutató ...semmelweis.hu/konzervalo-fogaszat/files/2015/11/Peri...Irritative factors 1. Microbial irritants: Streptococci, Lactobacilli,](https://reader031.vdocuments.net/reader031/viewer/2022021502/5aee886d7f8b9ac57a8c1dbe/html5/thumbnails/17.jpg)
4. Acute apical abscess
Etiology: is a localised and severe inflammatory response
(pulp necrosis)
Symptoms: pain, swelling, systemic maniestations (fever,
malaise, leukocytosis)
Vitality test: no response to thermal or electrical stimuli,
pain on percussion
Radiograph: thickening of the periodontal ligament space,
frank periapical lesion
Hystology: liquefaction necrosis, PMN leukocytes,
granulomatous tissue
Treatment: drainage, root canal therapy, to close!!!
![Page 18: Dr. Győrfi Adrienne - Semmelweis Egyetem | Kutató ...semmelweis.hu/konzervalo-fogaszat/files/2015/11/Peri...Irritative factors 1. Microbial irritants: Streptococci, Lactobacilli,](https://reader031.vdocuments.net/reader031/viewer/2022021502/5aee886d7f8b9ac57a8c1dbe/html5/thumbnails/18.jpg)
Treatment
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Treatment
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5. Chronic apical abscess
(Suppurativ apical periodontitis)
Etiology: pulp necrosis,
chronic apical periodontitis
Symptoms: sinus tract stoma,
asymptomatic or closure of the sinus
pathway causes pain
Vitality test: no response to thermal or electrical stimuli
Radiology: similar as in chronic apical periodontitis
Hystology: similar to that of chronic apical periodontitis
Treatment: root canal therapy
![Page 21: Dr. Győrfi Adrienne - Semmelweis Egyetem | Kutató ...semmelweis.hu/konzervalo-fogaszat/files/2015/11/Peri...Irritative factors 1. Microbial irritants: Streptococci, Lactobacilli,](https://reader031.vdocuments.net/reader031/viewer/2022021502/5aee886d7f8b9ac57a8c1dbe/html5/thumbnails/21.jpg)
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5. Chronic apical abscess
(Suppurativ apical periodontitis)
Etiology: pulp necrosis,
chronic apical periodontitis
Symptoms: sinus tract stoma,
asymptomatic or closure of the sinus
pathway causes pain
Vitality test: no response to thermal or electrical stimuli
Radiology: similar as in chronic apical periodontitis
Hystology: similar to that of chronic apical periodontitis
Treatment: root canal therapy
![Page 23: Dr. Győrfi Adrienne - Semmelweis Egyetem | Kutató ...semmelweis.hu/konzervalo-fogaszat/files/2015/11/Peri...Irritative factors 1. Microbial irritants: Streptococci, Lactobacilli,](https://reader031.vdocuments.net/reader031/viewer/2022021502/5aee886d7f8b9ac57a8c1dbe/html5/thumbnails/23.jpg)
Differential diagnosis
Normal structure (anatomic variations):
canalis mandibulae, foramen mentale,
sinus maxillaris, foramen incisivum, dental
papillae of developing teeth etc.
Nonendodontic pathosis:
benign lesions: cementoma, monostatic fibrous
dysplasia, traumatic bone cyst, ameloblastoma,
central hemangioma etc.
malignant lesions: chondrosarcoma, myeloma
![Page 24: Dr. Győrfi Adrienne - Semmelweis Egyetem | Kutató ...semmelweis.hu/konzervalo-fogaszat/files/2015/11/Peri...Irritative factors 1. Microbial irritants: Streptococci, Lactobacilli,](https://reader031.vdocuments.net/reader031/viewer/2022021502/5aee886d7f8b9ac57a8c1dbe/html5/thumbnails/24.jpg)
Foramen
incisivum
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Foramen mentale
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Sinus maxillaris
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Dental papillae
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