Diseases of periradicular tissues by dr ramesh bharti
Dr Ramesh Bharti
Introduction As a consequence of pathologic changes in the dental pulp,may or may not initiate formation and perpetuation of periradicular lesions.Depending on the nature and quantity of irritants,as well as the duration of exposure of the periradicular tissues, a variety of tissue changes can occur.When the irritants are transient in nature, the inflammatory process is short-lived and self-limiting.
.However, with an excessive amount of irritants or persistent exposure, the nonspecific and specific immunologic reactions can cause destruction of periradicular tissues. In addition to bacterial irritation, the periradicular tissues can be mechanically irritated and inflamed. Physical irritation of periradicular tissues can also occur during root canal therapy if the canals are instrumented or filled beyond their anatomic boundaries.
Periradicular tissues can be irritated by impact trauma, hyperocclusion, endodontic procedures and accidents, pulp extirpation, overinstrumentation, root perforation,and overextension of filling materials.
PERIRADICULAR LESIONS OF PULPALORIGIN Irritation of pulpal or periradicular tissues results in inflammation. The major irritants of these tissues can be divided into-1.Living and 2.Nonliving irritants. The living irritants are various microorganisms and viruses. The nonliving irritants include mechanical, thermal,and chemical irritants..
Mild to moderate injuries of short duration cause reversible tissue damage and recovery of these tissues. Persistent and/or severe injuries usually cause irreversible changes in the pulp and development of periradicular lesions.
CLINICAL CLASSIFICATION OF PERIRADICULAR DISEASES Periradicular lesions are divided into three main clinical groups: (A)-Symptomatic (acute) apical periodontitis, (B)Asymptomatic(chronic) apical periodontitis, (C)Apical abscess.
DISEASES OF THE PERIRADICULAR TISSUES Diseases of the periradicular tissues can be classified as: 1) Acute periradicular diseaes. A) Acute alveolar abcess. B) Acute apical periodontitis. a) Vital b) Non vital 2) Chronic periradicular diseases with areas of rarefactions. a) chronic alveolar abscess. b) Granuloma c) Cysts
3) Condensing osteits. 4) External root resorption. 5) Diseases of periradicular tissues of non endodontic origin.
ACUTE APICAL PERIODONTITISDEFINITION:It is a painful inflammation of theperiodontium as a result of trauma,irritation orinfection through the root canal regardless of whetherthe pulp is vital or non-vital. The tooth is extremely sensitive to percussion.
• ETIOLOGYA) IN VITAL TEETH: Occlusal trauma caused by abnormal occlusal contacts. Occlusal trauma caused by recently inserted restoration extending beyond the occlusal plane. By wedging of foreign objects between the teethe.g toothpicks By blow to a tooth.
B) IN NON-VITAL TOOTH:1) As a sequale of a pulpal disease.i.e diffusion of bacterial and necrotic pulp products.2) Iatrogenic cause like : Root canal over instrumentation. Inadvertently forcing bacteria through the apical foramen. Forcing of medicaments e.g formacresol. Over filling of root canals causing impinging of obturating material on the peri-apical tissue.
SYMPTOMS: 1) Pain,tenderness of the tooth. 2) The tooth may feel extruded making closure painful.DIAGNOSIS: Frequently made from known history of tooth under treatment. The tooth is tender on percussion whereas the mucosa overlying the root apex may not be tender to palpation. Radiographic examination may show thickening of pdl.or a small area of rarefaction if a pulpless tooth is involved.
DIFFERENTIAL DIAGNOSIS: It should be made between acute alveolar abscess. At times the difference is only one of degree.TREATMENT: It mainly consists of determining the cause and relieving the symptoms
(B)Asymptomatic(chronic) apical periodontitis Asymptomatic apical periodontitis (AAP) may bepreceded by SAP or by an apical abscess. However,the lesion frequently develops and enlarges withoutany subjective signs and symptoms.