periradicular diseas

Click here to load reader

Post on 23-Jan-2018

1.105 views

Category:

Health & Medicine

4 download

Embed Size (px)

TRANSCRIPT

  • CONTENTS

    INTRODUCTIONETIOLOGYDIAGNOSISCLASSIFICATION:REFERNCESMCQs

  • INTRODUCTION

    Pulpal disease is only one of the several cause of disease of periredicular tissues because of the inter-relationship

    between the pulp and periredicular tissues.

    Pulpal inflammation causes inflammatory changes in the periodontal ligament even before the pulp becomes totally

    necrotic.

  • ETIOLOGY

    =Most common microorganisms:

    streptococcus

    peptostreptococcus

    provotella

    =Black pigmented microorganisms:

    enterococcus

    fusobacterium

    porphyromonas

    eubacterium

  • DIAGNOSIS

    Extra oral examination:

    skintone

    facial asymmetry

    swelling

    extra oral sinus

    sinus tract

    tender or enlarged cervical lymphnodes

  • Intra oral examination :

    soft tissue and teeth to look for discoloration, abrasion, restoration, etc

  • CLINICAL PERIAPICAL TESTS Percussion

    Indicates inflammation of periodontium.

    Palpation

    Determines how far the inflammatory process has extended periapically.

    Pulp vitality

    Thermal tests which can be heat or cold.

    Electrical pulp testing.

  • Periodontal examination

    a) probing

    Determines the level of connective tissue attachment.

    b) mobility

    Determine the status of periodontal ligament .

  • Radiographic examination:

    Pulpal origin have four characteristic_

    -Loss of lamina dura apically.

    - Radiolucency at apex regardless of cone angle.

    - Radiolucency resembles a hanging drop.

    -Cause of pulp necrosis is usually evident.

  • _CLASSIFICATION_

    1.Acute periradicular disease:

    a) acute apical periodontitis:

    - vital.

    - nonvital.

    b) Acute alveolar abscess.

    c) Phoenix abscess.

  • 2.Chronic periredicular disease with areas of rarefaction:

    a) Chronic apical periodontitis:

    - Chronic alveolar abscess.

    - periapical granuloma.

    - cystic apical periodontitis\radicular cyst.

    b) persistant apical periodontitis.

  • 3.Condensing osteitis.

    4.External root resorption.

    5.Disease of the preiredicular tissues of nonendodonticorigin.

  • _ACUTE APICAL PERIODONTITIS_

    It is defined as painful inflammation of the periodontium as a result of trauma, irritation or infection of the periodontium as a result of trauma, regardless of whether the pulp is vital or nonvital.

  • ETIOLOGY:-

    In vital tooth,

    -Occlusal trauma

    -high points in restoration

    -wedging or farcing object between teeth.

    In non vital tooth,

    -it is associated with sequelae to pulpal

  • Diseases.

    Tooth is tender on percussion.

    Dull, throbbing and constant pain.

    Pain occurs over short period of time.

    Negative or delayed vitality test.

    No swelling.

    Pain on biting.

    Cold may relieve pain or no reaction.

    Heat may exacerbate pain or no reaction.

    No radiographic sign.

  • inflammatory reaction occur in apicalperiodontal ligament

    Dilatation of blood vessels

    Initiation of inflammatory response of polymorphonuclear leukocytes and round cells

    Accumulation of serous exudate

    Distention of periodontal ligament and extrusion of tooth, slight tenderness

    If irritation continues

    Loss of alveolar bone

  • Endodontic therapy should be initiated on the affected tooth at theearliest.

    To control postoperative pain following initial endodontic therapy,analgesics are prescribed.

    Use of antibiotics, either alone or in conjunction with root canaltherapy is not recommended.

    If tooth is in hyperocclusion, relieve the occlusion.

    For some patients and in certain situations, extraction is analternative to endodontic therapy.

  • _ACUTE APICAL ABSCESS_

    It is a localized collection of pus in the alveolar bone at the root apex of the tooth, following the death of pulp with extension of the infection through the apical foramen into periradiculartissue.

  • ETIOLOGY:-

    Invasion of bacteria from necrotic pulp tissue.

    Trauma chemical or mechanical injury.

    Irritation by chemical or mechanical treatment during RCT.

  • SIGNS AND SYMTOMS:-

    Tooth is nonvital.

    Rapid pain.

    Slight tenderness.

    Palpable fluctuant swelling.

    Mobility.

    Tooth may be in hyperocclusion.

    Increased WBC count.

  • Polymorphonuclear leukocytes infiltrate and initiate inflammatory response

    Accumulation of inflammatory exudates in response to active infection

    Distention of periodontal ligament

    Extrution of the tooth

    If the process continues, separation of periodontal ligament

    Tooth becomes mobile

    Bone resorption at apex

    Localized lesion of liquefaction necrosis containing polymorphoneuclearleukocytes,debries,cell remanents and purulent exudates.

  • TREATMENT:-

    Nonsurgical endodontic treatment.

    Incision and drainage.

    Extraction.

    In case of localized infection, antibiotics provide.

    In case of systemic complication, antibiotics given in addition to drainage of tooth.

    To control postoperative pain, nonsteroidal anti-inflammatory drugs are given.

  • _PHONIX ABSCESS_

    It is defined as an acute inflammatory reaction superimposed on an existing chronic lesion, such as cyst or granuloma.

    Occurs due to lowering of the body defence or increasing of virulence or due to blockage of sinus of chronic abscess by pus or debris.

    Tooth may be tender to touch.

    As inflammation progress, tooth may be elevated in the socket and may become sensitive.

    Mucosa over the radicular area may be sensitive to palpation and may appear red and swollen.

  • TREATMENT:-

    Establishment of drainage.

    Once symptoms subside complete RCT can be done.

  • _PERIAPICAL GRANULOMA_

    It is one of the most common sequelae of pulpitis.

    It is usually described as a mass of chronically inflamed granulation tissue found at the apex of nonvital tooth.

    Periapical granuloma is a cell-mediated response to pulpal bacterial products.

    Bacterial toxins cause mild irritation of periapical tissues.

    This leads to cellular proliferation and thus granuloma formation.

  • CLINICAL FEATURES:-

    Mostly asymptomatic.

    Sometimes pain and sensitivity is seen.

    Tooth is not sensitive to percussion.

    No mobility.

    No response to thermal or electric test.

    Lesions are discovered on radiographic examination.

  • RADIOGRAPHIC FEATURES:-

    Thickening of periodontal ligament at the root apex seen.

    Size may small lesion to large radiolucency exceeding more then 2cm in diameter.

    Root resorption is also seen.

  • HISTOPATHOLOGIC FEATURES:-

    It consists of inflamed granulation tissue that is surrounded by a fibrous connective tissue wall.

    The granulation consist of dense lymphocytic infiltrate which further contains neutrophils, plasma cells, histiocytes and eosinophils.

  • TREATMENT:-

    In restorable tooth-

    root canal therapy is preferred.

    In non-restorable tooth-

    extraction followed by curettage of all apical soft tissue.

  • _CYSTIC APICAL PERIODONTITIS/RADICULAR CYST_

    It is an inflammatory cyst which results because of extension of infection from pulp into the surrounding periapical tissue.

  • ETIOLOGY:-

    Caries.

    Irritating effect of restorative materials.

    Trauma.

    Pulpal death due to development defects.

  • It is frequently asymptomatic.Discovered when periapical radiograph of teeth with nonvital pulpis taken.Males>Females.Seen in 3rd and 4th decades of life.Site:-Highest in maxillary anterior.

    -In Mandible posteriors, separate small cysts arise from eachapex of

    multirooted teeth.Slowly enlarging swelling.Involved tooth is usually nonvital, discolored, fractured or showsfailed root canal.

  • PATHOGENESIS:-

    Periapical granuloma are initiated and maintained by the degradation prducts of necrotic pulp tissue.

    Cyst formation occurs as a result of epithelial proliferation.

    Sometimes. Epithelial plugs protrude out from the apical formation resulting in a pouch connected to the root and continuous with the root canal. This termed is POCKET or BAY CYST.

  • RADIOGRAPHIC FEATURES:-

    It appears as round, pear or ovoid shaped radiolucency.

    Endodontic treatment.

    Apicoectomy.

    Extraction.(severe bone loss).

  • _CHRONIC ALVEOLAR ABSCESS_

    It is known as suppurative apical periodontitis which is associated with gradual egress of irritants from root canal system into periradicular area leadinf to formation of an exudate.

  • ETIOLOGY:-

    It is similar to acute alveolar abscess.

    It also result from necrosis.

    It is associated with chronic apical periodontitis that has formed an abscess.

    Sinus is seen.

  • SYMPTOMS:-

    It is Generally asymptomatic.

    Detected by presence of a sinus in a radiograph.

  • DIAGNOSIS:-

    If patient give a history of sudden sharp pain.

    Clinical examination may show-

    A large carious exposure, a restoration of

    composite,acrylic,amalgam or metal.Discoloration of crown of teeth.

    Vitality test is negative because of presence of necrotic pulp.

    Radiograph show-

    Diffuse area of rarefaction.

  • TREATMENT:-

    Removal of irritant from root canal and e