Histopathology of Periapical Disease Flashcards Preview

Pulpal Disease > Histopathology of Periapical Disease > Flashcards

Flashcards in Histopathology of Periapical Disease Deck (15)
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Causes of inflammatory PA disease

Trauma - physical, high fillings, bruxism, malocclusion. chemical leakage
Infection - caries


Symptomatic (acute) PAP - features

Confined to PA space
Greater proprioception - localised pain
Slight widening of PDL space
Elevated tooth due to vasodilation and oedema


Progression of symptomatic PAP

Acute periapical abscess
Anaerobic bacteria present within periapical space
Minute radiographic changes


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


Asymptomatic (chronic) PAP

AKA periapical granuloma
Clinically sound
Significant radiographic changes
Mass of inflamed fibrous connective tissue replacing lost bone


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


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


Types of inflammatory radicular cyst

Apical - at root apex
Lateral - at side of tooth
Residual - persists after extraction of affected tooth


Reactive/neoplastic conditions

Osteosclerosis - changes in bone structure


Rarefying Osteitis

- acute
- loss of bone
- inflammatory widening of PA space


Focal sclerosing osteitis

- ill defined radiopacity - suggesting bone growth
- osteoblasts have laid down more bone to 'confine' infection
- bone has become sclerotic


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


Cemento-Osseous dysplasia

- reactive lesions
- several radiopacities around roots and edentulous areas


Florid cemento-osseous dysplasia

- masses of fused bone
- calcified bodies which become larger


Neoplastic condition - cementoblastoma

- 10-40 y/o
- benign neoplasm
- radiopaque lesion attached to root
- usually Md Molar
- resembles osteoblastoma
- sheets of osteoid and cementum