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![ACUTE APICAL
PERIODONTITIS
• Definition:-Acute apical periodontitis is a painful inflammation of
periodontium as a result of trauma, irritation [or] infection through root
canal regardless of whether pulp is vital or non-vital.
• ETIOLOGY:-
In a vital tooth:
Occlusal trauma
Wedging of foreign object b/w the teeth
Blow to the teeth](https://image.slidesharecdn.com/differentialdiagnosisforperiapicalradiolucency-220812093807-3ac10d1f/75/DIFFERENTIAL-DIAGNOSIS-FOR-PERIAPICAL-RADIOLUCENCY-pptx-11-2048.jpg)
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DIFFERENTIAL DIAGNOSIS FOR PERIAPICAL RADIOLUCENCY.pptx
- 1.
- 2. • CLASSIFICATION TRUE FALSE TRUEPERIAPICAL RADIOLUCENCIES:- PULPOPERIAPICAL RADIOLUCENCIES DENTIGEROUS CYST PCOD PERIODONTAL DISEASE TRAUMATIC BONE CYST NON RADICULAR CYST MALIGNANT TUMORS
- 3. PSEUDO PERIAPICAL RADIOLUCENCIES:- ANATOMICRADIOLUCENCIES
- 4. ANATOMIC RADIOLUCENCIES • False periapicalradiolucencies are produced by anatomic varients that do not contact the apex of the tooth. • These radiolucencies may be shifted from the periapex by taking additional periapical radiographs at different angle. • If radiolucencies are anatomic in origin,a comparision with the radiographs of the opposite side frequently reveals an identical situation.
- 5. • MANDIBLE 1.Mandibular foramen 2.Mandibularcanal 3.Mental foramen 4.Lingual foramen 5.Submandibular fossa 6.Mental fossa 7.Midline symphysis • MAXILLA 1.Intermaxillary suture 2.Incisive foramen 3. Nasal fossa
- 10. APICAL PERIODONTITIS • Apicalperiodontitis is the inflammation of the periodontal ligament around the root apex. • It is of 2 types :- Acute Chronic
- 11. ACUTE APICAL PERIODONTITIS • Definition:-Acuteapical periodontitis is a painful inflammation of periodontium as a result of trauma, irritation [or] infection through root canal regardless of whether pulp is vital or non-vital. • ETIOLOGY:- In a vital tooth: Occlusal trauma Wedging of foreign object b/w the teeth Blow to the teeth
- 12. • In anon-vital tooth: As a sequlae to pulpitis Iotrogenic Forcing of medicaments Extension of obturating material Over instrumentation during cleaning & shaping
- 13. Clinical features pain Tooth isslightly elevated from the socket Tenderness on percussion Tooth may be slightly sore or may become sore on percussion Thermal changes does not induce pain.
- 14. RADIOGRAPHIC FEATURES • Slightwidening of PDL
- 15. • DIFFERNTIAL DIAGNOSIS Acutealveolar abscess- Histologically Treatment:-Root canal treatment.
- 16. PERI APICAL GRANULOMA •Most common type of pathologic radiolucency C/F :- • Tooth is non vital • It sounds dull on percussion due to granulation tissue at the apex. • Pt complains of mild pain on chewing. • R/F • Well circumscribed rl surrounding apex • Involved tooth may reveal deep rest`ns extensive caries. • Swelling or expansion of cortical plates is unusual.
- 18. Differential diagnosis Radicular cyst:-Cyst is larger than granuloma but it is may not always right. If radiolucency is1.6cm or more it is more likely to be cyst. Surgical defects:-previous history should taken PCOD:-pulp is vital & frequently involves lower anteriors TRAUMATIC BONE CYST:-pulp vital, mostly seen in lower posteriors,LD intact
- 19. TREATMENT ROOT CANAL TREATMENT EXTRACTIONOF EFFCTED TOOTH
- 20. ABSCESS • Abscess isan localised collection of pus surrounded by an area inflammed tissue in which hyperemia & infiltration of leucocytes is mark • ETIOLOGY:- trauma • chemical or mechanical irritation • pulpal infection
- 21. ACUTE PERIAPICAL ABSCESS Clinicalfeatures:- Deep caries Pain & mobility discoloration fever & lymphadenopathy tender on percussion
- 22. CHRONIC PERIAPICAL ABSCESS • CLINICALFEATURES:- non-vital tooth pain may present swelling sinus opening vestibular tenderness tender on percussion
- 24. RADIOGRAPHIC FEATURES • LOCATION:-present at the apex of involved tooth • PHERIPHERY:-ill defined • INTERNAL STRUCTURE:-radiolucent • SURROUNDING STRUCTURES:-loss of LD in the peri apical region
- 26. DIFFERENTIAL DIAGNOSIS • PERIODONTALABSCESS • NON –ODONTOGENIC CYST
- 27. MANAGEMENT • Analgesics • Antibiotics •Root canal treatment • Extraction
- 28. PERI APICAL CYST CLINICALFEATURES:- usually asymptomatic mostly seen in maxillary incisors if large produces swelling
- 30. RADIOGRAPHIC FEATURES • LOCATION:-Presentsat apex of tooth • PHERIPHERY & SHAPE:-well defined pheriphery with cortical border, outline is curved or circular • INTERNAL STRUCTURE:-Radiolucent • EFFECT ON SURROUNDING STRUTURES:-If cyst is large,displacement & resorption of adjacent tooth may occur
- 32. DIFFERENTIAL DIAGNOSIS • periapical granuloma • pcod • traumatic bone cyst • mandibular infected buccal cyst
- 33. MANAGEMENT • ROOT CANALTHERAPY • EXTRACTION • FOR LARGE CYST WHERE BONE DESTROYED 1.surical ennucleation 2. surgical ennucleation & restoration of defect with graft 3. marsupilization 4. Decompression 5.decompression with delayed ennucleation 6.creation of a common chamber with maxillary sinus or nasal cavity
- 35. PERI APICAL SCAR •Peri apical scar is a dense fibrous tissue situated at the periapex of non vital tooth. Features :- well circumscribed radiolucency i.e., more or less round resembles granuloma/cyst & it is usually small. mostly in anterior of maxilla. rl remains constant in size/ shrink slightly.
- 38. 5.SURGICAL DEFECT It isan area that fails to fill in with osseous tissue after surgery. Seen periapically after root resection procedures when both labial & lingual plates have been destroyed. Mucosal scar due to previous surgery. R/F Usually round in app, smoothly contoured,well defined borders. Rl not more than 1cm in diameter. D/D SCAR
- 40. OSTEOMYELITIS • Defined asinflammation of bone & marrow components. • Streptococci, staphy.aureus, staphy.albus & anaerobes like bacteroides, prevotella. Predisposing factors:- Fractures due to trauma. Road traffic accidents. Gun shot wounds &Radiation damage Pagets disease & osteopetrosis Sys cond. Leukemia,malnutn,diabetes
- 41. • Clinical features:- 30to 80 yrs. Mostly seen in mandible. Tooth is non-vital may be associated with acute/chronic periapical abscess. Sinus is seen mucosa & skin.
- 42. RADIOGRAPHIC FEATURES • LOCATION:-Post.bodyof mandible. • Periphery & shape ;-Irregularly shaped with poor or ragged borders. • Internal struc:-Radiolucent. • Effect on surrounding struc:-LD lost. Can stimulate either resorption / formation of bone.
- 45. DIFFERENTIAL DIAGNOSIS • CHRONICALVEOLAR ABSCESS • EOSINOPHILIC GRANULOMA • PAGETS DISEASE
- 46. HYPERPLASIA OF MAXILLARY SINUSLINING • It appear as grey shadows that may be dome shaped in maxillary sinus floor • Radicular cyst can pouch into the sinus & may show a thin curved radioopaque rim of bone seperating the cyst from the sinus cavity
- 47. DENTIGEROUS CYST • Itis an odontogenic cyst assosiated with crown of unerupted tooth CLINICAL FEATURES:- Clinical examination reveals a missing tooth & a hard swelling results in facial asymmetry
- 48. RADIOGRAPHIC FEATURES • LOCATION:-Presentabove the crown of involved tooth • PHERIPHERY:-Well defined • INTERNAL STRUCTURE:-Radiolucent except for crown of unerupted • SURROUNDING STRUCTURES:-Can displace & resorb the adjacent teeth
- 51. DIFFERENTIAL DIAGNOSIS • HYPERPLASTICFOLLICLE • OKC • CYSTIC AMELOBLASTOMA
- 52. MANAGEMENT • Smaller lesionscan surgically removed • Larger lesions –insertion of surgical drain or marsupilization
- 53. PERIAPICAL CEMENTO OSSEOUS DYSPLASIA •SYNONYMS:- Sclerosing cementum Periapical osteo fibrosis Fibrocementoma Periapical fibrosarcoma ETIOLOGY:- Trauma or Local irritation
- 54. • CLINICAL FEATURES:- .Mostly present in mandibular anterior region . No history of pain/sensitivity . Occasionally lesion near the mental foramen and impinge on mental nerve & produces pain /parasthesia /even anaesthsia .Tooth have vital pulp
- 55. RADIOGRAPHIC FEATURES • LOCATION:-Apexof the tooth • PHERIPHERY:-Well defined • INTERNAL STRUTURE:-Radiolucent surrounded by hyperostotic border • Loss of lamina dura
- 57. DIFFERENTIAL DIAGNOSIS • TRAUMATICBONE CYST • CEMENTOBLASTOMA • MANAGEMENT:- Surgical ennucleation
- 58. TRAUMATIC BONE CYST •SYNONYMS:- Solitory cone cyst Hemorrhagic cyst Extravasation cyst Unicameral bone cyst Simple bone cyst Idiopathic bone cyst ETIOLOGY:- Trauma
- 59. • CLINICAL FEAATURES:- Mostlyseen in young persons More male predilection Present mostly in posterior mandible Occasional tender on percussion
- 60. RADIOGRAPHIC FEATURES • LOCATION:-mandibleposterior part • PHERIPHERY:-well defined delicate cortex to ill defined border that blends into surrrouding structure • INTERNAL STRUCTURE:-total radiolucent • SURROUNDING STRUTURE:-sometimes root resorption & displacement may present
- 62. DIFFERENTIAL DIAGNOSIS • pcod •radicular cyst • median mandibular cyst
- 63. MANAGEMENT • Conservative openinginto the lesion & careful curettage of the lining this usually initiates the bleeding & subsequent healing
- 64. NON ODONTOGENIC CYST •incisive canal cyst • midpalatine cyst • median mandibular cyst • primordial cyst
- 66. Malignant tumours • Squamouscell carcinoma • Malignant tumors of minor salivary gland • Osteolytic sarcoma • Chondrosarcoma • Melanoma • Reticulum cell sarcoma • Multiple myeloma
- 67. • FEATURES:- More commonin middle & old age May be pain Involve may retain their vitaliity Advance cases :-tooth migration, loosening , tipping, spreading Gingival bleeding may also present paresthesia/anesthesia of the soft tissues Expansion of jaw in advanced cases
- 68. RADIOGRAPHIC FEATURES • Welldefined or poorly defined radiolucency or a large ragged well defined radiolucent tumor • Root resorption & band like widening of periodontal ligament space
- 71. MANAGEMENT:- Proper diagnosis hasto be done to treat the affected tooth . Extensive management is recommended if microscopic study of periapical tissue after root resection is diagnosed as malignancy.
- 72.