PERIAPICAL RADIOLUCENCIES

-By Namrata Ingavale.

 Contents
• Acute and Chronic dentoalveolar abscess
• Surgical defects
• Osteomyelitis
 Acute and chronic dentoalveolar abscess

• Def :- Localised collection of purulent

exudates (pus) in a cavity formed by the
disintegration of tissues
• An abscess is a natural defence mechanism in
which the body attempts to localise an
infection and wall off the microorganisms so
that they cannot spread throughout the body.
 Etiology
• Bacterial invasion of pulp from carious lesion
• Toxins from necrotic pulp
• Tooth trauma
• Acute exacerbation of cronic situation
• Iatrogenic
• Partially /Previously endodontically treated
Pathogenesis
 CHRONIC AND ACUTE DENTOALVEOLAR
ABSCESS
• PRIMARY/ NECROTIC • SECONDARY/
1. Inflammation/infectious RECRUDESCENT
conditions associated with 1.Develop in a previously
teeth that have not existing asymptommatic
developed apperent periapical radiolucent
periapical radiolucent lesion(e.g:
lesions. granuloma,cyst,scar)
 Clinical features
• Tooth with an acute abscess is painful on percussion.
• feels high to bite on
• The tooth may demonstrate increased mobility.
• If permitted to progress without treatment , the
abscess may penetrate the cortical plates at the
thinnest and closest point to the apex and form a
space infection in the adjacent soft tissue
• Space abscess is painful and surface feels warm and
rubbery to palpation and demonstrates fluctuation.
 Radiographic features
• Diffuse radiolucency with irregular margins
• This radiolucency gradually merges with the
surrounding bone
• The lamina dura of offending tooth is
discontinuous in the periapical area
 DIFFERENTIAL DIAGNOSIS
• Secondarily infected primary tumor or
secondary tumor
• Non odontogenic cyst
• Periodontal abscess
 MANAGEMENT
• Immediate drainage should be achieved.
• Systemic phase: oral penicillin G has been a
standard but amoxicillin may give better
results.
 SURGICAL DEFECT
• A surgical defect in bone is an area that fails
to fill in with osseous tissue after surgery, and
it accounts for approximately 3% of all the
radiolucencies.
• It is frequently seen periapically after root
resection procedures , especially when both
lingual and labial plates are destroyed.
 FEATURES
• Periapical radiolucency is usually rounded in
appearance , is smoothly contoured and has
well defined borders(diameter< 1cm).
• On time to time radiographs are taken after
root resection procedure, radiolucency
decreases in size.
• It is completely asymptomatic and scar is seen
 MANAGEMENT
• Correct identification and periodic
surveillance with radiographs
 OSTEOMYELITIS
• DEF: It is an inflammatory process of bone
that begins in medullary spaces and extends
to cortical bone, cancellous bone and the
periosteum
 REVERSIBLE IRREVERSIBLE
DENTAL CARIES
PULPITIS PULPITIS

OSTEOMYELITIS PULP NECROSIS

 ETIOLOGY
• Sequele of periapical Infection
• Sequele of compound fracture of bone
• Hematogenous spread of infection
• PREDISPOSING FACTORS:-
1) Chronic debiliating illness
2)Reduced vascularity of bone
3)Pre existig bone disease
4)Sickle cell anemia
 MICROBIOLOGY
• Usually mixed infection
• Staphylococcus aureus
• Staph. Viridance
• E. coli
• Fusobacterium
• Klebsiella
• Others: Actinomyces.
 PATHOGENESIS
• Periapical infection
• Thrombus
• Obstruct blood supply
• Infection moves outside
• Perforates and comes out of periosteum
• Hypovascular, Hypoxic, Hypocellular
• Dead bone
 CLASSIFICATION
SUPPURATIVE NON SUPPURATIVE
• ACUTE SUPPURATIVE CHRONIC SCLEROSING
CHRONIC SUPPURATIVE a) FOCAL
b) DIFFUSE
INFANTILE GARRE’S OSTEOMYELITIS
OSTEORADIONECROSIS
 CLINICAL FEATURES
• Mandible is more commonly affected than maxilla.
• Usually a predisposing factor is present.
• Deep intense pain
• Intermittent fever
• Mobile teeth sensitive to percussion.
• Pus discharge with extraoral or intraoral sinus
tract: suppurative type
• Bony hard tender swelling – non suppurative type.
 RADIOGRAPHIC FEATURES
• Early acute osteomyelitis- No radiographic changes
• Earliest change : Hazy appearance of trabecule
• Advanced lesion: Bone destruction: ill defined
radiolucent/osteolytic lesion
• Islands of necrotic bone within the osteolytic
lesion- sequestrum
• Sequestrum appears as areas of radiopacity
• The sequestrae may be single , multiple,small or
large
• Teeth are devoid of bone support: floating tooth
appearance
• Lamina dura of teeth in affected area is missing
• In children, the cortical outline of developing
follicles become inconspicuous
• Deposition of involucrum is seen as full grey
shadow
• Overall radiographic appearance of osteomyelitis
is defined as ‘ moth – eaten.’
 NON-SUPPURATIVE OSTEOMYELITIS
• Focal sclerosing osteomyelitis – localised
areas of dense bone formation
• Diffuse sclerosing osteomyelitis – wide spread
area of dense bone formation
• Garre’s osteolyelitis- periosteal reaction in
laminated form- onion peel appearance -
children
NON SUPPURATIVE OSTEOMYELITIS
 Differential diagnosis
• Chronic alveolar abscess
• Eosinophilic granuloma
 TREATMENT
• Identify the etiology and predisposing factors
• Adequate antibiotic coverage
• Culture sensitivity if required
• Surgical debridement
• Sequestrectomy.