Apical Periodontitis

[?] of the tooth is the most common cause of inflammatory lesion around the apex of a tooth root.

Bacterial invasion of the pulp

It is a likely outcome of untreated dental caries (tooth decay), and in such cases it can be considered a sequela in the natural history of [?]

Tooth decay

Irreversible pulpitis

Pulpal necrosis

Bacterial invasion of the pulp of the tooth is the most common cause of inflammatory lesion around the apex of a tooth root. It is a likely outcome of untreated dental caries (tooth decay), and in such cases it can be considered a sequela in the natural history of tooth decay, irreversible pulpitis and pulpal necrosis.

Periapical disease

Periapical disease is classified as 

Symptomatic apical periodontitis

Asymptomatic apical periodontitis

Symptomatic apical periodontitis (x3)

Inflammation of the apical periodontium producing clinical symptoms including painful response to biting and percussion.

It may or may not be associated with an apical radiolucent area.

It includes Acute Apical Periodontitis and Phoenix Abscess

Causes of Symptomatic apical periodontitis (x4)

In a vital tooth, may be caused by abnormal occlusal contacts or trauma by a blow to the teeth

In a nonvital tooth, irritants entering the periapical tissues from a necrotic pulp

Root canal instrumentation forcing irritating medicaments, bacteria or debris through the apical foramen

Extension of obturating material through the apical foramen

Perforation or overinstrumentation during cleaning and shaping of root canals

Treatment of Symptomatic apical periodontitis

Disocclusion

RCT

Extraction

Inflammation of the apical periodontium producing clinical symptoms including painful response to biting and percussion.

Symptomatic apical periodontitis

It includes Acute Apical Periodontitis and Phoenix Abscess

Symptomatic apical periodontitis

Asymptomatic apical periodontitis

Inflammation and destruction of apical periodontium that is of pulpal origin

Appears as an apical radiolucent area and does not produce clinical symptoms.

Previously called Chronic Apical Periodontitis

Radiographic features of Asymptomatic apical periodontitis

 Thickened periodontal ligament at the root apex

A radiolucent area seemingly attached to the root apex

Area of rarefaction is small (usually less than 1.0 cm. in diameter) well defined (circumscribed lesion)

Lack of continuity of the lamina dura

Treatment of  Asymptomatic apical periodontitis

RCT

Extraction