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Periapical periodontitis; Other names: Apical periodontitis, periradicular periodontitis: Periapical dental radiograph showing chronic periapical periodontitis on the root of the left maxillary second premolar. Note large restoration present in the tooth, which will have undergone pulpal necrosis at some point before the development of this lesion.
Periapical granuloma, [1] also sometimes referred to as a radicular granuloma or apical granuloma, is an inflammation at the tip of a dead (nonvital) tooth. It is a lesion or mass that typically starts out as an epithelial lined cyst, and undergoes an inward curvature that results in inflammation of granulation tissue at the root tips of a dead tooth.
It may develop rapidly from a periapical granuloma, as a consequence of untreated chronic periapical periodontitis. [ 1 ] Periapical is defined as "the tissues surrounding the apex of the root of a tooth " and a cyst is "a pathological cavity lined by epithelium , having fluid or gaseous content that is not created by the accumulation of pus."
In 1890, W.D. Miller, considered the father of oral microbiology, was the first to associate pulpal disease with the presence of bacteria. [11] This was confirmed by Kakehashi, who, in 1965, proved that bacteria were the cause of pulpal and periradicular disease in studies using animal models; pulpal exposures were initiated in both normal and germ-free rats, and while no pathologic changes ...
Periapical COD occurs most commonly in the mandibular anterior teeth while focal COD appears predominantly in the mandibular posterior teeth. Florid COD is an extensive variant of periapical COD where lesions occur in multiple quadrants which can encompass the maxilla and mandible, and infrequently can cause jawbone deformity.
Periapical readiograph of lower right teeth, showing a large carious lesion in the distal of the lower right second molar. The same tooth also has an extensive periodontal defect. At this stage, without further information, it is difficult to tell which process has occurred first and lead to the death of the pulp.
The initial lesion appears within two to four days of gingival tissue being subjected to plaque accumulation. When not generated through clinical experimentation, the initial lesion may not appear at all, and instead, a detectable infiltrate similar to that of the early lesion, explained below, appears. [19] Features of the Initial Lesion: [15]
A phoenix abscess is an acute exacerbation of a chronic periapical lesion. It is a dental abscess that can occur immediately following root canal treatment. Another cause is due to untreated necrotic pulp (chronic apical periodontitis). [1] It is also the result of inadequate debridement during the endodontic procedure.