Flashcards in Histopathology of Periapical Disease Deck (15)
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1
Causes of inflammatory PA disease
Trauma - physical, high fillings, bruxism, malocclusion. chemical leakage
Infection - caries
2
Symptomatic (acute) PAP - features
Confined to PA space
Greater proprioception - localised pain
Slight widening of PDL space
Elevated tooth due to vasodilation and oedema
3
Progression of symptomatic PAP
Acute periapical abscess
Anaerobic bacteria present within periapical space
Minute radiographic changes
4
Progression of symptomatic PAP (2) and routes of infection
Acute alveolar abscess
Further spread of bacteria via pus
Via route of least resistance - PDL
Bone --> sinus infection
Antrum entry --> spread into sinuses - into IO region
Soft tissues --> cellulitis
Bone --> osteomyelitis
5
Asymptomatic (chronic) PAP
AKA periapical granuloma
Clinically sound
Significant radiographic changes
Mass of inflamed fibrous connective tissue replacing lost bone
6
Histology of periapical granuloma
Fibrous capsule filled with vascular connective tissue
Lymphocytes, macrophages and plasma cells. Neutrophils if inflamed
Scattered remnants of epithelium (RofM)
Bone resorption
7
Progression of A(C)PAP granuloma
Radicular cyst
Epithelium proliferates and then breaks down after reaching growth capacity - becomes necrotic
Fluid accumulates and forms cyst
Cholesterol also accumulates
8
Types of inflammatory radicular cyst
Apical - at root apex
Lateral - at side of tooth
Residual - persists after extraction of affected tooth
9
Reactive/neoplastic conditions
Osteosclerosis - changes in bone structure
10
Rarefying Osteitis
- acute
- loss of bone
- inflammatory widening of PA space
11
Focal sclerosing osteitis
- ill defined radiopacity - suggesting bone growth
- osteoblasts have laid down more bone to 'confine' infection
- bone has become sclerotic
12
Hypercementosis and potential causes
- more common in older its
- reactive changes due to loss of fx (partially erupted/unerupted/overgrowth)
- inflammation due to PD
- Paget's disease - abnormal bony turnover
- Idiopathic - unexplained
- cementum can become fused with tooth - ankyloses
13
Cemento-Osseous dysplasia
- reactive lesions
- several radiopacities around roots and edentulous areas
14
Florid cemento-osseous dysplasia
- masses of fused bone
- calcified bodies which become larger
15
