This document discusses different types of apical lesions in dentistry, including periapical abscesses, apical granulomas, and radicular cysts. It defines each lesion, describes their causes and clinical features, and outlines their radiographic appearances and recommended treatments. Periapical abscesses result from tooth infections and present as gingival swelling and pain. Apical granulomas form in response to tooth pulp necrosis and cause dull tooth pain. Radicular cysts arise from epithelial residues and present as jaw swelling that may become soft and fluctuant if infected.

1. DEPARTMENT OF ORAL
MEDICINE AND RADIOLOGY
TOPIC: APICAL LESIONS IN DENTISTRY
SUBMITTED BY,
GOPIKA SUKUMARAN
INTERN
REG NO: 1311210026

2. DEFINITION
• The lesions commonly found at the apices of non-vital tooth.

3. APICAL LESIONS
PERIAPICAL ANSCESS APICAL GRANULOMA RADICULAR CYST

4. PERIAPICAL ABSCESS
DEFINITION:
• Collection of pus at athe root of a tooth
• Caused by infection that spread
• From tooth to the surrounding tissues.

5. CAUSES:
• “Infant bottle”tooth decay or
“ nursing” caries
• Broken teeth
• Periodontal disease
• Failed root canal treatment
• Plaque

6. CLINICAL FEATURES:
GINGIVA
• Swelling
• Warmth
• Erythema
• Fluctuant mass that usually extends towards buccal side of the gum and to
the gingival – buccal reflection
• Parulis or “gum boil”
TEETH
• Most frequently involved lower third molar
• Increased mobility
• Extrusion

7. LYMPH NODES
• Regional lymph node involvement
SEVERE INFECTION
• Trismus ( indicating involvement of the masticator space)
• Difficulty in swallowing (dysphagia)
• Respiratory difficulty
• Necrotizing fasciitis
COMPLICATION
• Neck or face swelling
• Dehydration

8. RADIOGRAPHIC FEATURE:
EARLY STAGE-
Within the first ten days, no radiographic features
PLAIN RADIOGRAPH/ OPG AND CT
• Well – defined radiolucency at or distal to the tooth apex
• Less than 1cm with or without surrounding sclerosis
• Signs of caries in involved tooth
• An empty socket may indicate recent extraction or infection

9. TREATMENT AND PROGNOSIS:
 Drainage must be established
• Open pulp chamber
• Extract the tooth

10. APICAL GRANULOMA
• DEFINITION
• A growing mass of granulation tissue
• Surrounding the apex of a nonvital tooth
• Arising in response to necrosis of the tooth pulp
• Also known as apical granuloma, dental granuloma

11. CLINICAL FEATURE:
o Tooth is always nonvital
o Constant dull, throbbing pain
o Pain on biting or on percussion
o Percussion- produce a dull sound instead of a normal
metallic sound, because of the presence
of granulation tissue around
the tooth apex
o Tooth feels slightly elongated in its socket

12. RADIOGRAPHIC FEATURE:
 Earliest evidence
• Thickening of ligament at root apex
 Proliferation of granulation tissue
 Concomitant resorption of bone continue

13. TREATMENT AND PROGNOSIS:
 Left untreated, may undergo transformation into an
apical periodontal cyst
Proliferation of epithelial rests in the area
 Extraction of the involved tooth

14. RADICULAR CYST
DEFINITION:
• Cyst arising from epithelial residues in the periodontal ligament as a consequence
of inflammation
• Usually following the death of the dental pulp
• Most common odontogenic cyst

15. CLINICAL FEATURE:
 Usually asymptomatic
 Slowly progressive
If infection enters, the swallowing becomes painful and rapidly expands
(partly due to inflammatory edema)
 Initially swelling is round and hard
 Later, part of wall is resorbed leaving a soft fluctuant swelling,
bluish in color, beneath the mucous membrane.
 When bone has been reduced to egg shell thickness a cracking sensation
may be felt on pressure

16. RADIOGRAPHIC FEATURE:
• Peri- or para- apical, round or oval radiolucency of variable size
• Well defined and marked opaque rim
• Rarely induce resorption of the root.

17. TREATMENT AND PROGNOSIS:
 Under some conditions;
 Root canal therapy
 With apicoectomy of cystic lesion