dental therpy 4

1. Periapical lesionsPeriapical lesions

2. Normal periapical tissuesNormal periapical tissues

3. Normal periapical tissuesNormal periapical tissues
 No pain al allNo pain al all
 Not be abnormally sensitive to percussionNot be abnormally sensitive to percussion
or palpation testingor palpation testing
 Normal intact lamina duraNormal intact lamina dura
 Normal PDLNormal PDL

4. Symptomatic apicalSymptomatic apical
periodontitisperiodontitis
 painful inflammation of periodontiumpainful inflammation of periodontium
through root canal, regardless of whetherthrough root canal, regardless of whether
tooth is vital or non-vitaltooth is vital or non-vital
 Result:Result:
 trauma,trauma,
 irritationirritation
 infectioninfection

5. ETIOLOGYETIOLOGY
 IN VITAL TEETH
 - Abnormal occlusal contacts
 over occlual plan restoration
 foreign object between the teeth
 Trauma

6. IN NONVITAL TEETHIN NONVITAL TEETH
 Sequelae of pulpal diseases,
 Iatrogenic
 root canal instrumentation
 foramen Forcing of irrigating irrigants
 Extension of obturating material
 Perforation of the root
overinstrumentation during cleaning &
shaping of root canals.

7. Signs and SymptomsSigns and Symptoms
 Tender on percussion
 Dull, throbbing and constant pain
 pain on closure and mastication.
Negative or delayed vitality test
 Cold may relieve pain
 Radiographically, widening of the pdl
space


9. Treatment
 Treatment If tooth in hyper occlusion,
relieve occlusion
 If tooth infected, initiate endodontic
therapy

10. ASYMPTOMATICAPICALASYMPTOMATICAPICAL
 A clinical asymptomatic condition of
pulpal origin with inflammation and
destruction periapical tissues


11. ASYMPTOMATICASYMPTOMATIC
 Defined as a clinical asymptomatic
conditian of pulpal origin with inflammation
and destruction of periapical tissues.

12. Etiology
 Results from pulp necrosis and a
sequelae of symptomatic apical
periodontitis.


13. SIGNS AND SYMPTOMSSIGNS AND SYMPTOMS
 Does not respond to vitality test
 Percussion no pain Slight sensitivity to
palpation
 Radio graphically interruption in lamina
dura Destruction of periapical tissues


14. TreatmentTreatment
 Remove of necrotic pulpRemove of necrotic pulp
 Complete the opturationComplete the opturation