This document discusses different types of periapical lesions. Normal periapical tissues show no pain or sensitivity, have an intact lamina dura, and normal periodontal ligament. Symptomatic apical periodontitis is a painful inflammation of the periodontium through the root canal that can result from trauma, irritation, or infection, regardless of whether the tooth is vital or non-vital. Asymptomatic apical lesions are clinically asymptomatic conditions of pulpal origin that involve inflammation and destruction of periapical tissues. They result from pulp necrosis and can be detected through negative vitality tests, slight sensitivity to palpation, interruptions in the lamina dura on radiographs, and destruction of periapical

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