PERIAPICAL

DISEASES
CLASSIFICATION
Symptomatic periradicular diseases
a)symptomatic apical periodontitis
i) vital tooth
ii) non vital tooth
b)Acute alveolar abscess
c)Phoenix abscess
External root resorption
Persistent apical periodontitis
Asymptomatic periradicular diseases
a)Asymptomatic apical periodontitis
b)Chronic alveolar abscess
c)condensing osteitis
ACUTE APICAL PERIDONTITIS:
DEFINITION:
Symptomatic apical periodontitis is a painful
inflammation of the periodontism as a result of
trauma, irritation, or infection through the root
canal, regardless of whether the pulp is vital or
non-vital , producing clinical symptoms
including painful response to biting and
percussion.

CAUSES:
In vital tooth
-abnormal occlusal contacts
-inserted restoration extending beyond the occlusal
plane
In non-vital tooth
-sequelae of pulpal diseases
-Iatrogenic causes
SYMPTOMS:
-Pain and tenderness of the tooth
-Patient may have pain on closure and
mastication
DIAGNOSIS:
-Pain on percussion.
RADIOGRAPHIC CHANGES:
-Non vital tooth : Widening of apical
periodontal ligament and loss of lamina
dura.
-Vital tooth : No radiographic changes .

TREATMENT:
-Determining the cause and reliving the
ACUTE ALVEOLAR ABSCESS:
DEFINITION:
An acute alveolar abscess is an
inflammatory reaction to pulpal infection
and necrosis characterised by rapid
onset , spontaneous pain , tenderness
of tooth to pressure , pus formation and
eventual swelling of associated tissues .
CAUSES :
Trauma or chemical or mechanical
irritation , the immediate cause is
generally bacterial invasion of dead
pulp tissue .
SYMPTOMS:
-Tenderness of the tooth that may be
relived by continued slight pressure on
the extruded tooth to push it back into the
alveolus .
-
-Intra oral or extra oral swelling tender on
palpation .
-Patient may complaint of fever and
malaise.
-Patient may appear pale , irritable and
weakened from pain and loss of sleep.
-Slight raise in temperature .
DIAGNOSIS :
-Clinical examination
-Electric pulp test and thermal test .
RADIOGRAPHIC FEATURES :
Widening of periodontal ligament and
loss of lamina dura .

TREATMENT :
Drainage and controlling systemic
reaction .
PHOENIX ABSCESS:
DEFINITION:
This condition is an acute
inflammatory reaction superimposed on
an existing asymptomatic apical
periodontitis .
CAUSES:
- Noxious stimulus from the diseased
pulp can cause acute inflammatory
response .
- Lowering of body defences due to the
influx from the root canal.
SYMPTOMS:
- Inflammation progresses, the tooth
-The mucosa over the radicular area may
appear red and swollen.
RADIOGRAPHIC CHANGES:
Well-defined periradicular lesions
Widening of the periodontal ligament
spaces
DIAGNOSIS:
-Lack of response to vitality tests
diagnosis a necrotic pulp.
-On rare occasions, a tooth may response
-discoloration of the tooth.
-To the electric pulp test because fluid in
the root canal.

TREATMENT:
Drainage and controlling the systemic
reaction.
CHRONIC APICAL PERIODONTITIS:
DEFINITION:
Asymptomatic apical periodontitis is the
symptomless sequelae of symptomatic
apical periodontitis and is characterized
radiographically by periradicular
radiolucent changes and histologically by
the lesion dominated with macrophages,
lymphocytes, and plasma cells.
SYMPTOMS:
-May not produce any subjective reaction.
DIAGNOSIS:
RADIOGRAPHIC FEATURES:
- area of rarefaction is well-defined with lack of
continuity of the lamina dura
- tooth does not respond to thermal or electric
pulp tests.

TREATMENT:
Root canal therapy
CHRONIC ALVEOLAR ABSCESS:
DEFINITION:
A chronic alveolar abscess is a long-
standing, low grade infection of the
periradicular alveolar bone generally
symptomless and characterized by the
presence of abscess draining through the
sinus tract.
CAUSES:
Natural sequelae of death of pulp with
extension of the infective process
periapically.
SYMPTOMS:
RADIOGRAPHIC FEATURES:
Discontinuity of the lamina dura at the
periapex or ill-defined periapical
radiolucency.

TREATMENT:
RADICULAR CYST:
DEFINITION:
A cyst is a closed cavity or sac internally with
fluid or semisolid material.
SIGNS AND SYMPTOMS:
patient may complaint of dull aching pain or
may be asymptomatic
CLINICAL FINDINGS:
 tooth involved shows a deep carious lesion,
tender or non-tender on percussion .
 diffuse expansion of the cortical plates.The
affected site may reveal a well-defined bony
hard swelling.
 RADIOGRAPHIC FEATURES:
Well-defined radiolucency measuring >1.5cm
in diameter at the periapex of the tooth
surrounded by a sclerotic border

TREATMENT:
Surgical Enucleation
CONDENSING OSTEITIS:
DEFINITION
Condensing osteitis is adiffuse radiopaque
lesion believed to represent a localized bony
reaction to a low-grade inflammatory stimulus,
usually seen at the apex of a tppth in which
there has been a long-standing pulpal pathosis.

CAUSES:
Condensing osteitis is a mild irritation from pulpal
disease that stimulates osteblastic activity in the
alveolar bone
SYMPTOMS:
 Asymptomatic
 It is discovered during routine radiographic
examination
DIAGNOSIS:
 Osteitis appears in radiographs as a
localized area of radiopacity surrounding
the affected root.
 It is an area of dense bone with reduced
trabecular pattern
EXTERNAL ROOT
RESORPTION
External surface root resorption
Etiology
Luxtation injury to PDL ,
Traumatic occlusion
Orthodontic treatment
Clinical feature
asymptomatic ,mobility in short
roots
Radiograhic feature Negative
Treatment
Elimination of trauma ,no endodontic
treatmernt required.

External inflammation root resorption

Etiology
Long standing periradicular lesion
Abnormnal pressure
Clinical feature
Increased mobility , extruded
occasionally , presence of sinus tract
Radiographic feature
Progressive cavitation involving root
and alveolus bone at 2-4 week
Treatment
Mature teeth - shaping & cleaning &
use of caOH2 medicament for 2-4week
followed by obturation
Immature teeth - Caution regarding
the use of caHO2 for prolonged duration
due to its weakeing effect on the tooth .
MTA apexification is a valuable
alternative
External replacement root resorption
Etiology
Intrusion & reimplantation of avulsed
tooth
Clinical feature
Metallic sound on percussion
Radiographic feature
Root structure is replaced by bone
Internal root resorption
Etiology
Trauma , crown preparation , pulpotomy
,
Inflammed pulp
Clinical feature
Asymptomatic until the inflammatory
process communicate with the external
tooth surface .
Radiographic feature
Root canal outline distorted &
radiolucent defect appear continuous ,