Periapical inflammatory lesions occur as a local bone response around the apex of a tooth due to necrosis of the pulp or destruction of periapical tissues by periodontal disease. This includes conditions like acute/chronic apical periodontitis, periapical abscess, and periapical granuloma. Clinically, these lesions range from being asymptomatic to causing toothache, facial swelling, fever and lymphadenopathy. Imaging shows lytic or sclerotic changes around the apex that start within the periodontal ligament space and often have ill-defined borders, representing inflammation of the bone (osteitis) and resorption of bone (rarefaction).

1. PERIAPICAL INFLAMMATORY LESION
periapical rarefying osteitis
GOOD MORNING
I.A.AYISHA TALAT

2. DEFINATION
•• a•• local•••••• response••••••••• of••• the•••• bone••••• around••••••• the•••• apex••••• of••• tooth•••••• that••••• occurs••••••• as••• a•• result••••••• of•••
necrosis
•••••••••
of
•••
pulp
•••••
or
•••
through
••••••••
destruction
••••••••••••
of
•••
periapical
•••••••••••
tissue
•••••••
by
•••
extensive
••••••••••
periodontal
••••••••••••
disease.
•••••••
••• also••••• called••••••• acute•••••• apical••••••• periodontitis•••••••••••••• ,•• chronic•••••••• apical••••••• periodontitis•••••••••••••• ,•• periapical•••••••••••
abscess
••••••••
and
••••
periapical
•••••••••••
granuloma.
•••••••••

3. DISEASE MECHANISMS

4. CLINICAL FEATURES
ranges from being asymptomatic to
occasional toothache to severe pain
with or without facial swelling, fever
and lymphadenopathy.
periapical abscess manifests with
severe pain, mobility , elevation of
involved tooth and pain on
percussion.
spontaneous drainage of abscess
into the oral cavity through
fistula(parulis) relieve acute pain.

5. IMAGINING FEATURES
depends on the time course of the lesions.
early lesion may not show any changes and
diagnosis is based on in clinical examination.
chronic lesions show lytic (radiolucent) or
sclerotic (radiopaque) changes or both.
LOCATION: apex of the involved tooth. starts
within the apical portion of the pdl space.
PERIPHERY: mostly ill defined showing a gradual
transition from normal trabecular bone pattern to
abnormal bone pattern. rarely shows well defined
cortical boundaries.

6. RAREFYING OSTEITIS (Internal structure)
Inflammation of bone(osteitis) resulting in
resorption of bone(rarefaction).
The term is not a diagnosis but is a radiographic
interpretation that includes periapical cyst,
abscess and granuloma.
early lesion shows no changes in bone pattern but
usually results in widening of PDL space.
chronic lesions shows rarefaction (loss of bone
giving radiolucent appearance )
hence when lesion is undergoing bone resorption,
the term periapical rarefying osteitis is used

7. RADIOGRAPHS
reference:http://drgstoothpix.com/radiographic-interpretation/pulpalapical-findings/apical
-findings-inflammatory/rarefying-osteitis/

8. Reference: oral radiology and interpretation principles and interpretation (first
south Asian edition)