periodontal and periapical diseases n.
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Periodontal And Periapical Diseases. Periodontal Disease. Usefulness of Radiographs. Amount of bone present Condition of alveolar crest Bone loss in furcation areas Width of periodontal ligament Local factors: calculus, overhanging restorations Crown/root ratio. Limitations of Radiographs.

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usefulness of radiographs
Usefulness of Radiographs
  • Amount of bone present
  • Condition of alveolar crest
  • Bone loss in furcation areas
  • Width of periodontal ligament
  • Local factors: calculus, overhanging restorations
  • Crown/root ratio
limitations of radiographs
Limitations of Radiographs
  • No indication of morphology of bony defects
  • No indication of successful management
  • No indication of hard/soft tissue relationship, i.e., depth of pockets
normal alveolar crest
Normal Alveolar Crest
  • 1.0-1.5 mm apical to cemento-enamel junction
  • Parallel to line joining the CEJ of adjoining teeth
  • Smooth
  • Continuation of lamina dura, has the same radiopacity
evidence of early periodontitis
Evidence of Early Periodontitis
  • Localized erosion of crest of bone
  • Blunting of crest- anterior teeth
  • Loss of sharp angle between lamina dura and crest
  • Widening of PDL near crest
local factors
Local Factors
  • Calculus
  • Overhanging restorations
  • Poor restoration contours
direction of bone loss
Direction Of Bone Loss

Horizontal Bone Loss: Crest of bone is parallel to CEJ line between adjoining teeth. The remaining bone is still horizontal but may be positioned apically.

direction of bone loss1
Direction Of Bone Loss

Vertical bone loss

Crest of remaining bone is not parallel to the CEJ line between adjoining teeth (displays an oblique angulation to the CEJ line )

juvenile periodontitis early onset periodontitis rapidly progressing periodontitis
Juvenile Periodontitis(Early-onset Periodontitis, Rapidly Progressing Periodontitis)
  • Occurs in healthy individuals between puberty and age 25
  • Amount of bone loss is not consistent with local factors and oral Hygiene habits. Rate of bone loss is 3-4 times faster than in typical periodontitis
juvenile periodontitis cont
Juvenile Periodontitis(cont.)
  • Typically affects crestal bone of first molars and incisors. Eventually affects greater # of teeth.
  • Bone loss is progressive and frequently bilaterally symmetrical. Many teeth show vertical bone loss.
  • Host neutrophil dysfunction has been demonstrated by several investigators.
papillon lefevre syndrome
Papillon-Lefevre Syndrome
  • Autosomal recessive trait
  • Hyperkeratosis of palms and soles
  • Occasional keratosis of other skin surfaces
  • Calcification in falx cerebri
  • Severe destruction of alveolar bone involving all deciduous and perm. teeth
  • Exfoliation of teeth
langerhans cell histiocytosis histiocytosis x
Langerhans’ Cell Histiocytosis (Histiocytosis X)
  • Complex of three diseases:
  • Eosinophilic granuloma (usually solitary)
  • Hand-Schuller-Christian disease (chronic)
  • Letterer-Siwe disease (acute)
  • Due to abnormal proliferation of Langerhans’ cells or their precursors
eosinophilic granuloma of bone
Eosinophilic Granuloma of Bone
  • Most common in children and young adults
  • Usually single radiolucency
  • Skull, mandible, vertebra and long bones commonly involved
  • Painful, mobile teeth and gingival lesions
hand schuller christian disease
Hand-Schuller-Christian Disease
  • Most cases reported in children under 10 years. Has been reported in older individuals
  • Skeletal and soft tissues may be involved
  • Classic triad of symptoms:
    • “punched out” destructive bone lesions
    • unilateral or bilateral exophthalmos
    • diabetes insipidus
  • Complete triad occurs in 25% of patients
hand schuller christian cont
Hand-Schuller-Christian (Cont.)
  • Oral manifestations include:
    • loose teeth
    • exfoliated teeth
    • gingivitis
    • loss of alveolar bone / advanced periodontitis
  • Sharply outlined multiple radiolucent lesions in skull, jaws and other bones
letterer siwe disease
Letterer-Siwe Disease
  • Acute, disseminated form of disease
  • Usually occurs before age 3. Most patients die
  • Involves several bones and organs
  • Skin rash
  • Intermittent fever, enlargement of liver and spleen, lymphadenopathy common
  • Destructive radiolucencies in jaws
  • Loosening and premature loss of teeth
periapical inflammatory lesions
Periapical Inflammatory Lesions
  • Bone destruction around apex of tooth, mostly secondary to pulp exposure due to caries or trauma.
  • Bacterial invasion of pulp produces toxic metabolites which escape to the periapical bone through apical foramen and cause inflammation.
periapical inflammatory lesions1
Periapical Inflammatory Lesions
  • Periapical granuloma: Localized mass of chronic granulation tissue containing PMN’s, lymphocytes, plasma cells.
periapical granuloma
Periapical Granuloma
  • Radiographically, widening of PDL or variable size of periapical radiolucency may be present
periapical abscess
Periapical Abscess
  • Periapical abscess: When pus forms in the area. It may develop directly as an acute process or develop in a pre-existing granuloma. Radiographically, appears identical to granuloma.
periapical granuloma or abscess
Periapical Granuloma Or Abscess
  • Can one differentiate between the two on the basis of radiographs alone?
periapical inflammatory lesions2
Periapical Inflammatory Lesions
  • Radicular cyst (periapical cyst): Cell rests of Mallasez (remnants of epithelial root sheath of Hertwig) proliferate due to inflammatory stimulus of a granuloma or an abscess and provide the epithelial lining.
  • A cyst is an epithelium lined cavity which is filled with fluid or semi-solid material.
  • Radicular cyst is the ONLY cyst related to non-vital pulp.
periapical inflammatory lesions3
Periapical Inflammatory Lesions
  • Can you definitively differentiate between a periapical granuloma, abscess or radicular cyst on the basis of radiograph alone?
periapical inflammatory lesions4
Periapical Inflammatory Lesions
  • Sclerosing osteitis (chronic sclerosing osteomyelitis). Occasionally, the reaction to periapical inflammation is predominantly osteoblastic, i.e., more sclerotic bone is formed (radiopaque mass).
  • Usually occurs in children or young adults when the resistance is high.
  • Most common location is mandibular 1st molar.
  • How do you differentiate between osteosclerosis and condensing osteitis?
  • In osteosclerosis, the pulp is vital. There are no clinical signs or symptoms. No treatment is necessary.
  • Sclerosing osteitis is secondary to pulp exposure. Patient is symptomatic. Endodontic treatment or extraction is indicated.
calcific degeneration calcific metamorphosis

Calcific Degeneration(Calcific Metamorphosis)

Secondary to Trauma to the Tooth

radiographic evidence of non vital teeth
Radiographic Evidence Of Non-vital Teeth
  • Widening of apical PDL or periapical radiolucency ( associated with indication of pulp exposure)
  • Discontinuity of lamina dura
  • Displacement of lamina dura
  • Sclerosing osteitis
  • Calcific degeneration (metamorphosis)
  • Radiographic indication of pulp exposure
periapical cemental dysplasia
Periapical Cemental Dysplasia
  • Also called Cementoma. Localized alteration in periapical area. Osseous structure is replaced by fibrous tissue, cementum-like material, abnormal bone or combination of these.
  • Pulp is vital. Patient is asymptomatic. There are no clinical signs.
  • No treatment is required.
  • Mean age is 39 years.
periapical cemental dysplasia1
Periapical Cemental Dysplasia
  • 85% patients are females.
  • 3 times more common in African-americans.
  • Most commonly seen in mandibular anterior areas.
  • May be multiple.
  • May be bilateral.
  • Well-defined radiolucency, opacity or mixed.
periapical cemental dysplasia2
Periapical Cemental Dysplasia
  • Stage I ( Osteolytic stage )
  • Stage II ( Osteo or cementoblastic stage)
  • Stage III ( mature stage )
apical scar fibrous scar
Apical Scar (Fibrous Scar )
  • Variation in healing process. Normally surgical site fills with blood clot which organizes and eventually mineralizes and remodels like surrounding bone.
  • Occasionally, normal mineralization and remodeling fails to occur.
  • Patient is asymptomatic and no treatment is required.
periapical lesions bhaskar
Periapical Lesions (Bhaskar)
  • Periapical granuloma 48%
  • Radicular cyst 43%
  • Periapical abscess 1.1%
  • Residual cyst 3.5%
  • Apical scar 3.0%
  • Periapical cemental dysplasia 1.7%
  • Rare lesions 1.0%
rare periapical lesions bhaskar
Rare Periapical Lesions (Bhaskar)
  • Central giant cell granuloma
  • Traumatic (simple) bone cyst
  • Hyperparathyroidism
periapical lesions lalonde and leubke
Periapical Lesions(LaLonde and Leubke)
  • Periapical granuloma 45.2%
  • Radicular cyst 43.8%
  • Periapical abscess 3.0%
  • Other periapical lesions 8.0%