Abnormalities of the pulp

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Abnormalities of the pulp

  1. 1. ABNORMALITI ES OF THE PULP Prepared by: Dr. Rea Corpuz
  2. 2. Pulp Calcification may be located  pulp chamber OR  root canals
  3. 3. Pulp Calcification Cause  no clear-cut etiology  no relation between inflammation + irritation • since pulp calcification can be found in unerupted teeth
  4. 4. Sundell Schematic Presentation Local Metabolic Hyalinization Vascular TraumaDysfunction of injured cell Damage ThrombosisGrowth Mineralization Fibrosis Vessel Wall Damage Pulp Stones
  5. 5. Classification Three types :  (1) Denticles  (2) Pulp stones  (3) Diffuse linear calcifications
  6. 6. (1) Denticles believed to form as a result of epitheliomesenchymal interaction within developing pulp form during period of root development occur in root canal + pulp chamber adjacent to furcation areas of multirooted teeth
  7. 7. (2) Pulp Stones believed to develop around central nidus of pulp tissue examples:  collagen fibril  ground substance formed within coronal portions of pulp
  8. 8. (2) Pulp Stones may arise as part of age- related or local pathologic changes most develops after tooth formation is completed usually free or attached some instances, may be embedded
  9. 9. (3) Diffuse Linear Calcifications doesn’t demonstrate lamellar organization of pulp stones exhibit areas of:  fine  fibrillar  irregular calcification may be present in pulp chamber or canals frequency increases with age
  10. 10. (3) Diffuse Linear Calcifications Clinical Significance:  very little clinical significance  except insofar as they may obstruct endodontic treatment
  11. 11. (3) Diffuse Linear Calcifications Clinical Significance:  discovered on radiograph only as radioopacity  may cause pain from mild pulpal neuralgia to severe excruciating pain resembling tic douloureux • as denticle may impinge on nerve of pulp
  12. 12. (3) Diffuse Linear Calcifications Clinical Significance:  difficulty may be encountered in extirpating pulp during root canal therapy
  13. 13. (3) Diffuse Linear Calcifications Treatment & Prognosis  No treatment is required
  14. 14. Resorption of the Teeth deciduous teeth are progressively loosened  result of progressive resorption of roots  physiological process arising from pressure of underlying successors resorption of permanent is always pathological
  15. 15. Resorption of the Teeth Pathology  pressure is probably main factor  resorption is mainly carried out by osteoclast  humoral mediators, such as prostgalndins • may contribute to resorption
  16. 16. Idiopathic Resorption (1) Internal Resorption (2) External Resorption
  17. 17. Idiopathic Resorption Internal Resorption  pink spot  curious + uncommon condition  dentin is resorbed from within the pulp
  18. 18. Idiopathic Resorption (1) Internal Resorption  tends to be localized  well-defined rounded area of rediolucency in crown  can affect any part of teeth  NO signs until pulp is opened + allows access to infection
  19. 19. Idiopathic Resorption (1) Internal Resorption  may be detected by chance in routine radiograph
  20. 20. Idiopathic Resorption (1) Internal Resorption
  21. 21. Idiopathic Resorption (1) Internal Resorption
  22. 22. Idiopathic Resorption (2) External Resorption  may be localized or generalized  unkown cause  mild degree of inflammation is often suspected
  23. 23. Idiopathic Resorption (2) External Resorption
  24. 24. Idiopathic Resorption (2) External Resorption Heithersay Classification
  25. 25. Idiopathic Resorption (2) External Resorption  usually a limited area of root is attacked from external surface near amelocemental junction • resorption goes on until pulp is reached
  26. 26. Idiopathic Resorption (2) External Resorption  often preferentially destroys root before penetrating the pulp
  27. 27. Idiopathic Resorption (2) External Resorption  accessible defects may be amenable to restoration with mineral trioxide or other materials  long term success in infrequent; unpredictable
  28. 28. Idiopathic Resorption (2) External Resorption  Pathology • vascular granulation tissue replaces part or periodontal ligament or pulp • osteoclasts border the affected dentin or enamel
  29. 29. Idiopathic Resorption (2) External Resorption  Treatment • usually untreatable • if a pink spot in an incisor tooth is noticed at an early stage  endodontic treatment should be carried out before
  30. 30. Idiopathic Resorption (2) External Resorption  Treatment • resorption of teeth may result from pressure exerted by impacted teeth  indication for removal of unerupted teeth
  31. 31. DISEASES OFPERIAPICALTISSU ES Prepared by: Dr. Rea Corpuz
  32. 32. Diseases of Periapical Tissues (1) Periapical Abscess (2) Periapical Granuloma (3) Radicular Cyst (4) Phoenix Abscess (5) Condensing Osteitis
  33. 33. (1) Periapical Abscess also known as Dento-alveolar Abscess; Alveolar Abscess acute or chronic supporative process of dental periapical region usually arises as a result of infection
  34. 34. (1) Periapical Abscess abcess ay develop directly as an acute apical periodontitis following an acute pulpitis but more commonly it originates in an area of chronic infection
  35. 35. (1) Periapical Abscess Clinical Feature  presents features of acute inflammation of apical peridontium  tooth is extremely painful  slightly extruded from its socket
  36. 36. (1) Periapical Abscess Clinical Feature  chronic periapical abscess generally presents no clinical features  mild, circumscribed area of suppuration that shows little tendency to spread from local area
  37. 37. (1) Periapical Abscess Radiographic Feature  except for SLIGHT thickening of periodontal membrane  no roentgenographic evidence of its presence  chronic abscess, developing in a periapical granuloma • radioluscent area at apex
  38. 38. (1) Periapical Abscess
  39. 39. (1) Periapical Abscess Histopathologic Features  area of suppuration is composed chiefly of central area of disintegrating polymorphonuclear leukocytes  dilation of blood vessels in periodontal ligament
  40. 40. (1) Periapical Abscess Histopathologic Features  tissue surrounding area of suppuration contains serous exudate
  41. 41. (1) Periapical Abscess Treatment & Prognosis  drainage must be established • open pulp chamber • extract the tooth
  42. 42. (1) Periapical Abscess Treatment & Prognosis  under some circumstances tooth may be retained • root canal therapy
  43. 43. (1) Periapical Abscess Treatment & Prognosis  left untreated, spread of infection • osteomyelitis • cellulitis • bacterimia • formation of fistulous tract opening on skin or oral mucosa
  44. 44. (2) Periapical Granuloma also known as Apical Periodontitis one of the most common sequeala of pulpitis localized mass of chronic granulation tissue  response to infection
  45. 45. (2) Periapical Granuloma Clinical Features  1st evidence; spread beyond confines of tooth pulp  may be noticeable sensitivity of involved tooth to percussion  mild pain when biting or chewing on solid food
  46. 46. (2) Periapical Granuloma Clinical Features  some cases tooth feels elongated in its socket  sensitivity is due to • hyperemia • edema • inflammation of apical periodontal ligament
  47. 47. (2) Periapical Granuloma Radiographic Features  earliest evidence, thickening of ligament at root apex  proliferation of granulation tissue  concomitant resorption of bone continue
  48. 48. (2) Periapical Granuloma Radiographic Features  appear as a radiolucent area of variable size seemingly attached to root apex  some cases, well circumscribed lesion • definitely demarcated from surrounding bone
  49. 49. (2) Periapical Granuloma Histologic Features  arises as chronic process from onset  does not pass through an acute phase
  50. 50. (2) Periapical Granuloma Histologic Features  begins as: • hyperemia • edema of periodontal ligament with infiltration of chronic inflammatory cells  chiefly lymphocytes  plasma cells
  51. 51. (2) Periapical Granuloma Histologic Features  inflammation + locally increased vascularity of tissue • induce resorption of supporting bone adjacent to this area
  52. 52. (2) Periapical Granuloma Histologic Features  as bone is resorbed • proliferation of fibroblast + endothelial cells • formation of more tiny vascular channels • numerous delicate connective tissue fibrils
  53. 53. (2) Periapical Granuloma Treatment & Prognosis  extraction of involved teeth  under certain conditions, root canal therapy with or without subsequent apicoectomy
  54. 54. (2) Periapical Granuloma Treatment & Prognosis
  55. 55. (2) Periapical Granuloma Treatment & Prognosis  left untreated, may undergo transformation into an apical periodontal cyst • proliferation of epithelial rests in the area
  56. 56. (3) Radicular Cyst also known as Apical Periodontal Cyst; Periapical Cyst; Root End Cyst common not inevitable sequela of periapical granuloma originating as a result of:  bacterial infection  necrosis of dental pulp  following carious involvement of tooth
  57. 57. (3) Radicular Cyst Pathogenesis  initial reaction leading to cyst formation • proliferation of epithelial rest in the periapical area involved by granuloma • epithelial proliferation follows an irregular pattern of growth
  58. 58. (3) Radicular Cyst Clinical Features  asymptomatic  present no clinical evidence of their presence  seldom painful or even sensitive to percussion
  59. 59. (3) Radicular Cyst Clinical Features  represents chronic inflammatory process • develops only over a long period of time
  60. 60. (3) Radicular Cyst Radiographic Features  identical with periapaical granuloma  since the lesion is a chronic progressive one developing in a pre-existing granuloma • cyst may be of greater size than granuloma • due to longer duration
  61. 61. (3) Radicular Cyst Radiographic Features  occasionally, exhibits thin, radioopaque line around the periphery of radiolucent area • indicates reaction of bone to slowly expanding mass
  62. 62. (3) Radicular Cyst Radiographic Features
  63. 63. (3) Radicular Cyst Histologic Features  epithelium lining apical periodontal cyst is usually stratified squamous in type
  64. 64. (3) Radicular Cyst Treatment & Prognosis  similar to periapical granuloma • involved tooth may be removed • periapical tissue carefully curetted
  65. 65. (3) Radicular Cyst Treatment & Prognosis  under some condition; • root canal therapy • with apicoectomy of cystic lesion
  66. 66. (3) Radicular Cyst
  67. 67. (4) Phoenix Abscess localized collection of pus surrounded by an area of inflammed tissue  hyperemia  infiltration of leucocytes
  68. 68. (4) Phoenix Abscess
  69. 69. (4) Phoenix Abscess
  70. 70. (4) Phoenix Abscess can occur immediately following root canal treatment another cause is due to untreated necrotic pulp (chronic apical periodontitis) result of inadequate debridement during endodontic procedure
  71. 71. (4) Phoenix Abscess Bacteriology  Staphylococci are frequently associated with pus formation • produce enzyme called coagulase • causes fibrin formation • helps in walling off of lesion
  72. 72. (4) Phoenix Abscess Bacteriology • coagulase promotes virulence by inhibiting phagocytosis
  73. 73. (4) Phoenix Abscess Clinical Features  when palpated clinically • superficial abscess is fluctuant  offending tooth is carious + mobile  symptoms of acute inflammation • swelling • fever
  74. 74. (4) Phoenix Abscess Treatment  repeating endodontic treatment with improved debridement  tooth extraction  antibiotics may be indicated to control a spreading or systemic infection
  75. 75. (5) Condensing Osteitis also known as Chronic Focal Sclerosing Osteomyelitis unusual reaction of bone occuring in instances of extremely high tissue resistance or in cases of low grade infection
  76. 76. (5) Condensing Osteitis Clinical Features  occurs in almost young person before the age of 20 years old  commonly affected is mandibular 1st molar with large carious lesion
  77. 77. (5) Condensing Osteitis
  78. 78. (5) Condensing Osteitis
  79. 79. (5) Condensing Osteitis Clinical Features  associated with non vital teeth or teeth undergoing process of degeneration  tooth is usually asymptomatic  some cases, pain or tenderness • percussion • palpation
  80. 80. (5) Condensing Osteitis Radiographic Features  well circumscribed radiopaque mass of sclerotic bone surrounding  extending below apex of one or more roots
  81. 81. (5) Condensing Osteitis Histologic Features  dense mass of bony trabeculae with little interstitial marrow tissue
  82. 82. (5) Condensing Osteitis Histologic Features  dense mass of bony trabeculae with little interstitial marrow tissue  chronic inflammatory cells; plasma cells, lymphocytes are seen scanty in bone marrow
  83. 83. (5) Condensing Osteitis Treatment & Prognosis  endodontic treatment  extraction  surgical removal of sclerotic should not be attempted unless symptomatic
  84. 84. References: Books  Cawson, R.A: Cawson’s Essentials of Oral Oral Pathology and Oral Medicine, 8th Edition • (page 70-72)  Ghom, Ali & Mhaske, Shubhangi: Textbook of Oral Pathology • (pages 429-433)  Neville, et. al: Oral and Maxillofacial Pathology 3rd Edition • (pages 127-138) Shafer, et al: A textbook of Oral Pathology, 3rd Edition

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