1. Classification of periapical lesions
No pain , Not abnormally sensitive to palpation and Normal intact lamina Normal periodontal ligament
Normal periapical tissues percussion dura
Painful inflamation of periodontium as result of trauma , S &S : Histological :
irritation , or infection through root canal , regardless Dull throbing constant pain - PMN leukocyte , Macrophages in
tooth vital or non-vital - pain on biting or percussion localized area of apical region
Symptomatic apical periodontitis ------------------------------------------------------------------------ - negative or delayed vitality - Bone and root resorption
Etiology : extention of pulp inflamation test response ------------------------------------------------
- not associated with apical Treatment :
In vital tooth : associated with occlusal trauma , high resto
radiolucency - if tooth hyper occlusion , relieve
In non vital : associated with sequelae of pulpal infections
- widening PDL space occlusion
Over instrumentation , Extrusion of necrotic pulp or obturating
- cold may relieive the pain - if tooth infected , initate endodontic
material
- Heat exacerbate pain therapy
Clinical asymptomatic condition of pulpal origin with inflamation S &S : Hisological :
ASymptomatic apical periodontitis and destruction of periapical tissues . - not respond to vitality test - AAp lesions are classified as
------------------------------------------------------------------------ - no pain on percussion granulma or cyst
Etiology : Result from pulp necrosis and a sequale of SAP - slight sensitivity to palpation - periapical granuloma cosist of
------------------------------------------------------------------------------ - Radiographically : granulomatous inflammatory tissue
Treatment : interruption in lamina dura -peripical cyst has central cavity
- Removal of necrotic pulp -Destruction of periapical
filled with semisolid fluid lined by
tissue
- Compete obturation stratified squamous epitheluim
S&S = signs & symptoms

2. S&S: Hostological :
Acute apical abscess - rapid onset - PMN leucocytes
Localized collection of pus in the alveolar bone at root apex - spontaneous pain
Following the death of pulp and extension of infection through - Debris - cell remnants
- moderate to severe
apical foramen into periapical tissues . - Accumulation of exudates
discomfort with swelling
Etiology : - pain on percussion Treatment :
Liquefaction pulp necrosis And palpation - Removal of cause
Severe inflammatory response - radiographically : widening - Release of pressure , driange
Microbial non microbial irritant PDL to periapical lesion
- Root canal treatment
It's an inflammatory lesion of pulpal origin
Chronic apical abscess characterized by presence of long standing S&S :
lesion with driange into mucosal or skin ( sinus
Treatment :
tract ) - Asymptomatic
- pain - Drainage
Etiology : - presence of sinus tract
- Endodontic treatment
Abscess has burrowed through bone and soft
tissue to form sinus tract .
S&S :
Treatment :
Condesing osteitis - A variant of symptomatic apical periodontitis - Asymptomatic or associated
- irritant from canal to periodontitis with pain
- irritant from canal to periapical tissue in the cause - not respond to electric or Root canal treatment
- mainly in mand. posterior teeth thermal stimuli ( when indicated )
- occurs in association with apex of any tooth - may or may not be sensitive
to percussion
- Radiographically : radiopacity
, round root of tooth
BY : OSama Ahmad .. @Os_a_a | farabi.1@hotmail.com |