S&S = signs & symptoms

Classification of periapical lesions Normal periodontal ligament Normal intact lamina

dura

No pain , Not abnormally sensitive to palpation and percussion

Normal periapical tissues

Histological :

- PMN leukocyte , Macrophages in localized area of apical region - Bone and root resorption ------------------------------------------------

Treatment : - if tooth hyper occlusion , relieve occlusion - if tooth infected , initate endodontic therapy

S &S : Dull throbing constant pain

- pain on biting or percussion

- negative or delayed vitality test response

- not associated with apical radiolucency - widening PDL space

- cold may relieive the pain - Heat exacerbate pain

Painful inflamation of periodontium as result of trauma , irritation , or infection through root canal , regardless

tooth vital or non-vital ------------------------------------------------------------------------

Etiology : extention of pulp inflamation

In vital tooth : associated with occlusal trauma , high resto In non vital : associated with sequelae of pulpal infections Over instrumentation , Extrusion of necrotic pulp or obturating material

Symptomatic apical periodontitis

Hisological : - AAp lesions are classified as granulma or cyst - periapical granuloma cosist of granulomatous inflammatory tissue -peripical cyst has central cavity filled with semisolid fluid lined by stratified squamous epitheluim

S &S : - not respond to vitality test - no pain on percussion - slight sensitivity to palpation

- Radiographically : interruption in lamina dura -Destruction of periapical tissue

Clinical asymptomatic condition of pulpal origin with inflamation and destruction of periapical tissues .

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Etiology : Result from pulp necrosis and a sequale of SAP

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Treatment :

- Removal of necrotic pulp - Compete obturation

ASymptomatic apical periodontitis

BY : OSama Ahmad .. @Os_a_a | farabi.1@hotmail.com |

Hostological : - PMN leucocytes

- Debris - cell remnants - Accumulation of exudates

Treatment :

- Removal of cause - Release of pressure , driange - Root canal treatment

S & S : - rapid onset - spontaneous pain - moderate to severe discomfort with swelling - pain on percussion And palpation - radiographically : widening PDL to periapical lesion

Localized collection of pus in the alveolar bone at root apex Following the death of pulp and extension of infection through apical foramen into periapical tissues .

Etiology : Liquefaction pulp necrosis Severe inflammatory response Microbial non microbial irritant

Acute apical abscess

Treatment :

- Drainage

- Endodontic treatment

S&S :

- Asymptomatic - pain - presence of sinus tract

It's an inflammatory lesion of pulpal origin characterized by presence of long standing lesion with driange into mucosal or skin ( sinus tract )

Etiology : Abscess has burrowed through bone and soft tissue to form sinus tract .

Chronic apical abscess

Treatment :

Root canal treatment ( when indicated )

S&S :

- Asymptomatic or associated with pain - not respond to electric or thermal stimuli - may or may not be sensitive to percussion - Radiographically : radiopacity , round root of tooth

- A variant of symptomatic apical periodontitis - irritant from canal to periodontitis - irritant from canal to periapical tissue in the cause - mainly in mand. posterior teeth - occurs in association with apex of any tooth

Condesing osteitis