periapical lesions surround roots

1. Periapical
Radiopaque Lesions
‫[‘ميحرلا نمحرلا هللا مسب‬

2.  A variant of chronic (asymptomatic) apical periodontitis, represents
as an increase in trabecular bone in response to persistent irritation
( infected or necrotic pulp , usually posterior mandibular teeth)
( can occur around the apex of any tooth).
Signs and Symptoms
Depending on the cause (pulpitis or pulpal necrosis),
either asymptomatic or associated with pain. Pulp tissue
may or may not respond to electrical or thermal stimuli.,
tooths may or may not be sensitive to palpation or percussion.
 Radiographic Examination
Presence of a diffuse concentric arrangement of radiopacity
around the root of the tooth.
Condensing Osteitis (focal sclerosing osteomyelitis)
Treatment
Root canal treatment.
Condensing osteitis is often confused with
the nonpathologic entity, enostosis (sclerotic bone).

3.  Clinical Examination
 Tooth … asymptomatic , vital, Vertical percussion negative
 periapical cemental dysplasia
Common in African & in the mandibular anterior teeth .
 focal cemento-osseous dysplasia
(Caucasians), & predominantly in the mandibular posterior teeth
 florid cemento-osseous dysplasia
(African ) common in both maxilla and mandibular teeth in multiple
quadrants.
Cemento-Osseous Dysplasia
 Treatment….follow-up
A benign condition ,may arise from the fibroblast of the periodontal ligament, three types:-
 Radiographic Examination
 Abnormal bone (bone replaced with fibrous tissues)
 Lost dura lamina
 Radiolucent, mixed density or radio-opaque with radiolucent ring
.

4.  A focal area of increased radiodensity ,unknown cause, asymmetric, not
associated with detectable cortical expansion, and is typically detected
during a routine radiographic examination.
 terminology…. dense bone island, bone eburnation, bone whorl, bone scar,
enostosis, and focal periapical osteopetrosis
 IO is detected on ~5% (range 4-31%) of dental imaging.
Differential diagnosis
•condensing osteitis: occurs due to chronic
inflammation and is often associated with cries
and nonvital tooth.
 Most commonly (90%) in the mandible near the first molar
Radiographic features
 OPG , or cone-beam .
 usually solitary or multiple, size: 2-3 mm to 1-2 cm, round,
oval or irregular, Sclerotic, sharp margins without a
radiolucent rim
 periapical (80%) or remote to teeth (20%)

5. (cemental hyperplasia)
 A nonneoplastic deposition of excessive cementum.
 Radiographic Examination
 Thick or blunt root with intact lamina dura.
 My be isolated, involve multiple teeth, or appear as a generalized process.
 Most common, mandibular molars,
followed by the mandibular and maxillary
second premolars and mandibular first premolars
 Predominantly in adulthood, & the frequency increases with age.
 Generalized hypercementosis usually associated with
Paget disease of bone & most localized cases of
hypercementosis are not related to any systemic disturbance.
Treatment
No treatment.
Differential Diagnosis ( Large hypercementosis vs cementoblastoma)
 can be distinguished on the basis of associated pain, cortical expansion,
and continued enlargement.

6. Radiographic Examination
 OPG
 radiodense or mixed-density ,rounded appearance, with a
 Loss of the periodontal ligament space along with root
 resorption/loss of root outline are common.
Cementoblastomas
 A rare tumor of the cementum. previously described in the literature as cementomas, true
cementomas, sclerosing cementomas, periapical fibro-osteoma, and periapical fibrous dysplasia .
 Males & females ( 8-44 years)
 The usual location is around the apex of the premolars, originating from the tooth root, and usually
slowly enlarge, obliterating the periodontal ligament space
Treatment and prognosis
Recurrence is common with incomplete resection .
Differential diagnosis
•ossifying (cemento-ossifying) fibromas: very similar appearance
•osteoblastoma: very similar appearance but does not attach to
root

7. Periapical Radiopaque Lesions
Condensing Osteitis (focal sclerosing osteomyelitis)
 Boney proliferation due to apical inflammation
 Necrotic Tooth
 Amorphous Radiopacity with widened PDL
Treatment
Root canal treatment.

8. Periapical Radiopaque Lesions
Cemento-Osseous Dysplasia
 Bone replaced with fibrous tissues and abnormal bone
 Vital Tooth without lamina dura
 Radiolucent ,mixed density or radiopaque with radiolucent rim
Treatment….follow-up

9. Periapical Radiopaque Lesions
Idiopathic Osteosclerosis
 Area of increased bone density, unknowns origin
 Vital Tooth
 Amorphous Radiopacity with regular PDL space
Differential diagnosis
•condensing osteitis: occurs due to chronic
inflammation and is often associated with cries
and nonvital tooth.
Treatment….follow-up

10. Periapical Radiopaque Lesions
Hypercementosis
 Excessive build-up of normal cementum
 Vital Tooth
 Thick or blunt root with intact lamina dura
Treatment
No treatment.

11. Periapical Radiopaque Lesions
Cementoblastoma
 Rare benign neoplasm of cementum attached to root
 vital Tooth often painful
 Radiopacity with radiolucent rim obscuring root
Treatment
Surgical excision , Recurrence is common
with incomplete resection
Differential diagnosis
Osteoblastoma: very similar appearance
but does not attach to root

12. Periapical Radiopaque Lesions

13. Dr.Abdalazim Badraldin
Sudanese dental center
29 January 2022