Pathology of the pulpal and periradicular tissues 2012 2013

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The lecture describes the pathology of pulp dan periraducular tissues and the factors which affect the response of the pulp and periradicular area.

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Pathology of the pulpal and periradicular tissues 2012 2013

  1. 1. Endodontics  DB  305C  Module  1  Year  3.                                                                            Wan  Noorina  WA  
  2. 2. ¡  Explain  the  scope  of  endodontic  treatment  ¡  Explain  why  root  canal  treament  needs  to  be   carried  out  ¡  Describe  the  stages  of  root  canal  treatment  ¡  Describe  the  standards  of  treatment  ¡  List  the  factors  that  determine  the  success  of   treatment  
  3. 3. ¡  Characterize  aetiological  factors  causing  pulpal   inflammation  ¡  Explain  the  mechanism  of  spread  of  inflammation  in   the  pulp  and  periradicular  tissues  and  its   consequences  ¡  Explain  why  the  pulp  has  difficulty  in  recovering  from   severe  injury  ¡  Classify  the  pulpal  and  periradicular  lesions  ¡  Describe  the  step  involve  in  healing(resolution)  of   periradicular  lesions  following  successful  root  canal   treatment  ¡  Identify  in  general,  non-­‐endodontic  lesions  that  may   simulate  endodontic  periradicular  lesions  
  4. 4. ¡  Injuries  to  and  diseases   of  dental  pulp  and   periradicular  region  ¡  The  study  of  form,     function  and  health   ¡  The  prevention   of:-­‐               ¡  The  treatment           management    
  5. 5. ¡  The  clinical  management  that  consists  of   procedures  that  are  design  to  maintain  the  health  of   all  or  part  of  dental  pulp  ¡  When  pulp  is  diseased  or  injured,  treatment  aimed   at  preserving  the  normal  periradicular  tissues  ¡  When  infection  pursues,  treatment  is  aimed  at   restoring  the  periradicular  tissues  to  health  ¡  This  is  done  with  root  canal  treatment,  +  surgical   endodontics  
  6. 6. Healthy  pulp   Infected   Inflamed   Maintain  health   Root  canal  treatment  Pulpectomy   Root  canal  re-­‐treatment  Root  canal   Apical  surgery  treatment   Pulp  capping       Pulpotomy     (Restoring  The  Periradicular  (Preserving  The  Normal    Tissues  To  Health)  Periradicular  Tissues)          
  7. 7. WHY?  
  8. 8. ¡  Living  organisms   §  Micro-­‐organisms   ▪  Bacteria   ▪  Viruses   ▪  ?  Others  ¡  Non-­‐living  irritants   §  Mechanical   §  Thermal   §  Chemical    
  9. 9. ¡  Kakehashi  et  al.  The   ¡  Moller  et  al.  Influence   effects  of  surgical   on  periapical  tissues  of   exposures  of  dental   indigenous  oral   pulps  in  germ-­‐free  and   bacteria  and  necrotic   conventional   pulp  tissue  in  monkeys.   laboratory  rats.  Oral   Scant  J  Dent  Res   Surg  Oral  Med  Oral   89:475,  1981   Pathol  20:340;  1965  
  10. 10. ¡  Microorganisms     §  Toxins   §  By  products    ¡  Pulp  is  infiltrated    at  the  base  of  the  carious    tubules  by   §  Chronic  inflammatory  cells   §  Macrophages,  lymphocytes     §  Plasma  cells      
  11. 11. ¡  Pulp  tissue  will     §  Remain  inflamed  for  a  long   time  or   §  Undergo  necrosis  slowly  or   rapidly   ¡  Depending  on  ¡  Once  pulp  is  exposed,  pulp   §  Bacteria  virulence   is  infiltrated  by  PMN  to   §  Ability  to  release   form  liquefaction  area  at   inflammatory      fluids   the  site  of  exposure   §  Host     §  The  amount  of  circulation  ¡  Bacteria  colonize  and   §  Lymph  drainage   persist  at  the  site  
  12. 12. ¡  By  this  time  pulp  harbors   bacteria  and  by-­‐products.  ¡  Pulp  can  only  defend   temporarily  to  impede  the   spread  of  infection  and   tissue  destruction  ¡  More  irritantàmore   damage  and  will  spread   throughout  pulp  ¡  Subsequently  bac,  toxins  &   by-­‐products  will  diffuse   periapicallyàapical   inflammatory  lesions    ¡  Where  is  the  bacteria?  
  13. 13. §  Cavity  prep  (physical)  §  Cavity  prep  without  water  (physical  with  thermal)  §  Physical  pressure  on  the  prepared  tooth  (physical)  §  Deep  periodontal  curettage  (physical)  §  Occlusal  trauma  (physical)  §  Orthodontic  movement  (physical)  §  Dentine  expose  §  Dental  materials     ▪  Restorative  materials   ▪  Cements  
  14. 14. Chemical  irritants?    Leakage?   IEJ  42,  422-­‐444,  2009  
  15. 15. ¡  Mixed  pulpal  response  to  Dycal   after  3  months.  CP  (restorative   material  along  with  Dycal)  C:   Distinct    but  incomplete  hard   tissue  bridge  (BR),  revealing   gaps  on  either  side  of  BR  with   infiltrate  of  chronic   inflammatory  cells  
  16. 16. ¡  Who  can  survive  after  an  injury?    ¡  Type  of  injury  ¡  The  condition  of  the            pulp    ¡  Tissue  involve   §  Pulp  tissue    
  17. 17. ¡  Initial  response   §  Hard  tissue  formation     §  Examples?   §  How?  ¡  Moderate  to  severe  response   §  Inflammatory  process   §  Non  specific  inflammatory  mediators  and  specific   immune  reactions  
  18. 18. ¡  Direct  irritation   §  Hyper-­‐occlusion   §  Occlusal  trauma   §  Endodontic  procedural   accidents   §  Overinstrumentation   §  Overextention  of  GP   ▪  Physical     ▪  Chemical  ¡  Bacteria?  
  19. 19. 31  Jan  2005   16  Apr  2005   25  June  2005  
  20. 20. ¡  Healing   ¡  Osteoclastic  resorption   §  Regeneration   stops  resorbing  bone.   §  Repair  ¡  How  can  you  tell?    ¡  The  aim  of  RCT  is  to   ¡  In  healing  process,   remove  the  irritant  within   osteoblast  cells  will  start   the  canal   depositing  new  bone  and  ¡  Healing  by  repair  will  take   deposit  new  matrix.   place  once  the  irritant  is   removed  and   ‘inflammation’  process  for   healing  will  take  its  course    ¡  Immune  system  will  take   its  course  
  21. 21. REGENERATION  OR  REPAIR?  
  22. 22. ¡  Normal  pulp,  Healthy  pulp    ¡  Reversible  pulpitis   §  Symptoms   §  Treatment    ¡  Irreversible  pulpitis   §  Symptoms?  Asymptomatic?   §  Signs-­‐  PA?   §  Treatment   §  Hyperplastic  pulpitis   ▪  Chronically  inflamed  young  pulp  
  23. 23. ¡  Pulp  calcification    ¡  Internal  resorption   §  Lectures  in  Year  4    ¡  Pulpal  necrosis   §  Symptoms   §  Test  &  treatment   §  Not  responsive   §  PA  radiographs=  normal  
  24. 24. ¡  Normal  Periapical  tissues   ¡  Apical  abscess  ¡  Apical  periodontitis   §  Acute  apical  abscess   §  Acute   §  Rapid  onset,  painful   ▪  Moderate  to  severe  pain   §  No  swelling  if  confined  to   ▪  Tender  to  palpation   bone,  otherwise  swelling  is     ▪  Excruciatingly  painful  to   positive  as  collection  of  pus   percussion   seeps  through  path  of  least   ▪  May  or  may  not  respond  to  EPT   resistance:  soft  tissue   ▪  PA-­‐  Slight  widening  of  lamina   §  Tender  to  palpation  and   dura   percussion   §  Chronic  apical  periodontitis   §  PA-­‐  no  lesion,  +  ve  widening,   ▪  May  not  be  in  severe  pain   and  obvious   ▪  Tender  to  palpation   ▪  Tender  to  percussion   ▪  Not  responsive  to  EPT   §  Chronic  abscess   ▪  PA-­‐  apical  radiolucency   ▪  Presented  with  sinus  tract   ▪  +  PA  radiolucency  
  25. 25. ACUTE  APICAL  PERIODONTITIS   46  
  26. 26. ¡  CHRONIC  APICAL   PERIODONTITIS  
  27. 27. ¡  Acute  apical  abscess  
  28. 28. ¡  Chronic  Apical  Abscess  
  29. 29. ¡  Very  similar  to   ¡  Normal  structures   odontogenic  lesions   ¡  Non  odontogenic  ¡  Must  be  vigilant     diseases  ¡  Use  tests  to  guide   §  Early  stage  of   §  Clinical  findings   monostotic  fibro     §  Sensibility  testing   dysplasia   §  Ossifying  fibroma   §  PA  radiographs  ¡  Usually  response  to   §  Dentigerous  cysts   EPTs   §  Central  giant  cell   granuloma  
  30. 30.     Ameloblastoma  
  31. 31. Periapical  cemento-­‐osseous  dysplasia  
  32. 32. ¡  Harty’s,  Endodontics  in      Questions?   Clinical  Practice,  BS   Chong  2010  ¡  Endodontics  Principles   and  Practice  T  and   Walton  

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