Diseases of Periradicular Tisues

-Prashant Gaikwad
Classification
• 1.Acute Periradicular disease
• a)Acute apical periodontitis(symptomatic Periodontitis)
• b)Acute alveolar abscess
• c)Acute exacerbation of chronic apical periodontitis (phoenix abscess)
• 2.Chronic Periradicular disease
• a)Chronic apical periodontitis
-Chronic alveolar abscess
-Cystic apical periodontitis
• 3.Condensing osteitis
• 4.External root resorption
• 5.Diseases of the periradicular tissues of non endodontic origin
# ACUTE APICAL PERIODONTITIS
• It is a painful inflammation as a result of trauma, blow irritation or infection through the root canal regardless of whether the pulp is
vital or non vital.
- Causes
1) Vital tooth due to occlusal trauma
• Abnormal occlusal contact
• Recently inserted restoration (occlusal plane)
• Wedging(tooth pick)
• Traumatic blow to the teeth
2) Non vital tooth
• Sequealae of pulpal disease
• Iatrogenic
-Root canal instrumentation
-Forcing of irritating irrigands
-Extension of obturating material through apical foramen impinge on periapical tissue-
-Perforation of the root
-Overinstrumentation (Root canal)
• SYMPTOMS - Pain and tenderness of tooth
• DIAGNOSIS
- POP
-Radio examination may show thickened pdl
• DIFFERNTIAL DIAGNOSIS
- Acute apical periodontitis and acute alveolar abcess
• BACTERIOLOGY
- Bacteria enters through root canal
• HISTOPATHLOGY
- Inflammatory reaction in apical pdl
- Severe irritiaion cause osteoclast activity and breakdown of perioradicular bone causes acute
alveolar abscess
• TREATMENT
-Removal abnormal occlusion , removing all irritants and treated by conservative means
#ACUTE ALVEOLAR ABSCESS
-An acute alveolar abcess is a localised collection of pus in the alveolar
bone at root apex of tooth following death of the pulp with extension of the
infection through the apical foramen into periradicular tissue
• Causes
- Trauma or chemical or mechanical irritation
-Bacterial invasion of red puip tissue
• Symptoms
-First - Tederness of tooth
-Later - Throbbing pain, with attendent swelling of the overlying soft tissue
-Slightly rise in temperature
# DIAGNOSIS

-Radiograph help by showing a cavity , a defective restoration ,

thickened pdl space or evidence of breakdown of bone in the
region of root apex
-If the acute aiveolar abcess is an exacerbation of long standing
chronic alveolar abcess and area of, periapical rarfaction will be
evident on radiograph
-EPT and thermal test confirm diagnosis tooth may be tender to
percussion, or the patient may state it hurts while chewing
-The apical mucosa is tende to palpation and tooth maybe
mobile and extruded
• Bacteriology
- Concentration of microorganism is large in abcess
- Purulent material is sterile
• Histopathology
- Mononuclear cells
-PMNL
• Treatment
- Drainage and controlling the systemic reaction
#Acute Exacarbation Of Chronic Periodontitis
(Phoenix abscess)

• Causes
-Noxious stimulus from diseased pulp can cause acute
inflammatory response in this dormant lesions
-Root canal therapy
• Symptoms
- Tender on palpation
-Tooth get elevated, sensitive mucosa appear red and
swollened
• Diagnosis
-Exacerbation of chronic lesion most common associated with initiation of
RCT in completly asymptomatic teeh
• Differential diagnosis
-Acute alveoler abcess
• Bacteriology
-Abcess formrd due to microbial infection
-Sterile abcess
• Histopathology
-PMN Neutrophile and cellular debris
-Macrophages , lymphocyte and plasma cells
#CONDENSING OSTEITIS

-Low grade , chronic inflammation of periradicular area as a

result of mild irritation through the root canal
• Causes
-Mild irritation from pulpal diseases that stimulate
osteoblastic activity in alveolar bone
• Asymptomatic
• Diagnosis
- Radioopacity surrounding the affected root
-Dense bone with reduce trabicular pattern
• Histopathology
- Chronic inflammatory cells , plasma cells and lymphocytes
are seen in the scant bone marrow
• Treatment
-Removal of irritant stimulus
• Prognosis
-Lesions of condensing osteitis may persist after endodontic
treatment