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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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

Neoplastic condition - cementoblastoma

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