periapical granuloma .pptx

periapical granuloma .pptx

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  Periapical Granuloma: Understanding the Pathology Acomprehensive exploration of the definition, causes, symptoms, diagnosis, treatment options, complications, prevention, and management of periapical granuloma. by Zeynab Afzali
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  Definition of Periapical Granuloma Periapicalgranuloma refers to a localized inflammatory lesion that develops at the apex of a non-vital tooth, primarily caused by untreated dental caries and chronic pulpitis.
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  Causes of PeriapicalGranuloma Persistent Infection Untreated dental infections can lead to an inflammatory response in the periapical region, resulting in the development of granulomas. Dental Trauma Disruption of the tooth's blood supply following trauma can trigger an inflammatory cascade, leading to the formation of periapical granuloma. Foreign Bodies Presence of non-resorbable materials, such as root canal filling materials or broken instruments, can provoke an immune response and initiate granuloma formation. Genetic Factors A predisposition to immune dysregulation and altered response to infections may contribute to the development of periapical granuloma in certain individuals.
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  Symptoms and Signsof Periapical Granuloma 1 Asymptomatic Majority of cases are initially painless, with patients often unaware of the presence of a periapical granuloma. 2 Sensitivity to Pressure Discomfort may intensify upon applying pressure to the affected tooth during chewing or biting. 3 Swelling and Facial Pain Inflammatory response may cause localized swelling and mild to moderate facial pain in some cases. 4 Persistent Infections Recurrent episodes of abscess formation and drainage may occur, leading to exacerbation of symptoms. Case report Age : 55 Y Sex : M Endodontics Resident: Dr Maryam Babaahmadi CC : - discovered during routine dental X-rays. Anterior mandible periapical
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  Diagnosis of PeriapicalGranuloma Clinical Examination Visual inspection and palpation of the affected area to identify any visible signs of inflammation or localized tenderness. Histopathological Analysis Microscopic evaluation of a biopsy specimen to confirm the presence of chronic inflammation and characteristic granuloma formation. Imaging Techniques X-rays, cone beam computed tomography (CBCT), or magnetic resonance imaging (MRI) to visualize the extent and nature of periapical lesions.
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  Diagnosis of PeriapicalGranuloma Clinical Examination Visual inspection and palpation of the affected area to identify any visible signs of inflammation or localized tenderness. Histopathological Analysis Microscopic evaluation of a biopsy specimen to confirm the presence of chronic inflammation and characteristic granuloma formation. Imaging Techniques X-rays, cone beam computed tomography (CBCT), or magnetic resonance imaging (MRI) to visualize the extent and nature of periapical lesions.
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  Clinical features Tooth involvedis nonvital / slightly tender on percussion . Percussion may produce dull sound instead metallic due to granulation tissue at apex. Mild pain on chewing on solid food. Tooth may be slightly elongated in socket. Sensitivity is due to hyperemia , edema & inflammation of PDL in many cases , asymptomatic.
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  Histopathological features  Hyperemiaand edema of the PDL ligament with infiltration of chronic inflammatory cells.  Inflammatory and locally increased vascularity of the tissue are associated with resorption of the surrounding bone adjacent to this area.  Granulation tissue mass consists proliferating fibroblasts, endothelial cells & numerous immature blood capillaries with bone resorption .  Capillaries lined with swollen endothelial cells.  It is relatively homogenous lesion composed of macrophages, lymphocytes & plasma cells.
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  Histopathological features In somegranulomas,  Large number of phagocytes will ingest lipid material and become collected in groups forming foam cells.  Abundant mast cells may be found  Deposits of cholesterol as well as hemosiderin are often present and both are probably derived from the breakdown of extravasated RBCs. Epithelium of periapical granuloma can be derived from :  Respiratory epithelium of the maxillary sinus  Oral epithelium growing in through a fistulous tract  Oral epithelium proliferating apically from a periodontal pocket or bifurcation or trifurcation involvement by periodontal disease also with apical proliferation.
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  Histopathological features In somegranulomas,  Large number of phagocytes will ingest lipid material and become collected in groups forming foam cells.  Abundant mast cells may be found  Deposits of cholesterol as well as hemosiderin are often present and both are probably derived from the breakdown of extravasated RBCs. Epithelium of periapical granuloma can be derived from :  Respiratory epithelium of the maxillary sinus  Oral epithelium growing in through a fistulous tract  Oral epithelium proliferating apically from a periodontal pocket or bifurcation or trifurcation involvement by periodontal disease also with apical proliferation.
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  Histopathological features Dunlap andBarker – termed Giant cell hyaline angiopathy. Consists of inflammatory cell infiltration , giant cells , Rushton bodies , eosinophilic material resembling hyalinized collagen. Rest of Malassez may proliferate in response to chronic inflammation & may undergo cystification.
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  Histopathological features In somegranulomas,  Large number of phagocytes will ingest lipid material and become collected in groups forming foam cells.  Abundant mast cells may be found  Deposits of cholesterol as well as hemosiderin are often present and both are probably derived from the breakdown of extravasated RBCs. Epithelium of periapical granuloma can be derived from :  Respiratory epithelium of the maxillary sinus  Oral epithelium growing in through a fistulous tract  Oral epithelium proliferating apically from a periodontal pocket or bifurcation or trifurcation involvement by periodontal disease also with apical proliferation.
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  Radiographic features  Thickeningof PDL at root apex  As concomitant bone resorption & proliferation of granulation tissue appears to be radiolucent area.  Thin radiopaque line or zone of sclerotic bone sometimes seen outlining lesion.  Long standing lesion may show varying degrees of root resorption .
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  Treatment Options forPeriapical Granuloma 1 Non-Surgical Endodontic Therapy Routine root canal treatment to eliminate infection and promote healing of periapical tissues. 2 Apicoectomy Surgical removal of the granuloma- infected tissue from the apex of the tooth root, accompanied by root-end sealing to prevent re-infection. 3 Extraction In cases of persistent or irreparable damage, extraction of the affected tooth may be necessary, followed by appropriate prosthetic replacement.
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  Possible Complications ofPeriapical Granuloma • Persistent Infections • Cellulitis and Abscess Formation • Spread of Infection to Adjacent Structures • Oroantral Fistula Formation • Trismus and Restricted Mouth Opening
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  Prevention and ManagementStrategies Regular Dental Check-ups Scheduled visits to a dentist aid in early detection and timely treatment of dental caries and other potential causes of periapical granuloma. Effective Oral Hygiene Maintaining proper oral hygiene practices, including regular brushing, flossing, and use of antiseptic mouthwashes, reduces the risk of dental infections. Root Canal Disinfection Thorough cleaning and disinfection of the root canal system during endodontic therapy minimize the chances of residual infection and re- inflammation.