PERIAPICAL RADIOLUCENCIES

HARSHA VARDHAN K.V4TH B.D.SDEPARTMENT OF ORAL MEDICINE AND RADIOLOGYKAMINENI INSTITUTE OF DENTAL SCIENCES

INTRODUCTION

CONTENTS APICAL PERIODONTITIS. APICAL PERIODONTAL CYST. RESIDUAL CYST. PERIAPICAL ABSCESS .

1.APICAL PERIODONTITIS This is the inflammation of the periodontal

ligament around the apical portion of the root.

Through the inflammatory process here is similar to that occurring elsewhere there may be resorption of the Periapical bone and sometimes root apex.

This of two types: Acute apical periodontitis. Chronic apical periodontitis.

a. Acute apical periodontitis Patients suffering from acute apical

periodontitis usually give the history of previous pulpitis.

Due to the collection of inflammatory edema in the periodontal ligament the tooth

Is slightly elevated in its socket and causes tenderness while biting or even to mere touch.

RADIOGRAPHIC FEATURES: The radiographic appearance is

essentially normal at this stage except for a slight widening of periodontal ligament space.

b. Chronic apical periodontitis (Periapical granuloma) The acute inflammatory process is an

exudative process where as chronic one is proliferative.

Periapical granuloma is essentially a localized mass of chronic granulation tissue formed in response to the infection.

The involved tooth is generally non vital.

RADIOGRAPHIC FEATURES: The earliest Periapical change in the periodontal

ligament appears as a thickening of the ligament at the root apex.

As the proliferation of granulation tissue and concomitant resorption of bone continue the Periapical granuloma appears as a radiolucent area of variable size.

In some cases this radiolucency is a well circumscribed lesion, definitely demarcated from the surrounding bone.

The periphery of granulomas in other instances appears on the radiographs as a diffuse blending of the radiolucent area with the surrounding bone.

2.APICAL PERIODONTAL CYST (radicular cyst, Periapical cyst, root end cyst)

The apical periodontal cyst is the most common odontogenic cyst.

It is a true cyst, since the lesion consist of a pathological cavity that is lined by epithelium and is often fluid filled.

RADIOGRAPHIC FEATURES:The radiographic appearance of the apical periodontal cyst is identical in most cases with that of the Periapical granuloma. PERIPHERY AND SHAPE: Periphery usually

have a well-defined cortical border. If cyst is secondary infected, the inflammatory reaction of the surrounding bone may result in loss of cortex or alteration of cortex into more sclerotic border.

EFFECTS ON SURROUNDING STRUCTURE: If the cyst is large, displacement and resorption of roots of adjacent teeth may occur. In rare cases the cyst may resorb the roots of related non vital tooth.

3.RESIDUAL CYST The residual dental cyst results where a

collateral, lateral periodontal, radicular, or any cyst or granuloma remains after extraction of the tooth or a root.

RADIOGRAPHIC FEATURES: A round unilocular, radiolucency with

well-defined border in a edentulous area.

4.PERIAPICAL ABSCESS (Dento alveolar abscess, alveolar abscess) It is an acute or chronic supparative

process of the dental periapical region. It may develop either from acute

Periapical periodontitis or more commonly from a Periapical granuloma.

RADIOGRAPHIC FEATURES: The acute Periapical abscess is such a

rapidly progressive lesion that except for slight thickening of the periodontal ligament space, there is no radiographic evidence of its process.

The chronic abscess developing in a Periapical granuloma, presents for radiolucent area at the apex of the tooth described previously or the radiolucency may be ill defined.

BILBLIOGRAPHY SHAFER’S textbook of ORAL PATHOLOGY.

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