Radiology

can you radiographically distinguish the difference of a periapical abscess, granuloma, or cyst?

no, they’re histopathological terms

what is rarefying osteitis?

radiologic dx for inflammatory process associated with bone resorption at tooth apex

how does rarefying osteitis present radiographically?

localized area of increased radiolucency

how does sclerosing osteitis present radiographically?

relatively diffuse area of increased radiopacity

what is sclerosing osteitis (condensing osteitis)?

radiologic dx for inflammatory process associated with bone deposition at tooth apex

what is apical periodontitis?

clinical dx term for inflammation of apical periodontium of pulpal origin; used in endo; may or may not be seen on imaging

t/f clinical presentation always correlates with imaging findings

false; it may not necessarily correlate

acute disease s/x

• severe pain / swelling

• pain on palpation / percussion

• tooth mobility

how might pain be relieved in acute disease?

drainage of pus thru fistula or parulis

what is the primary modality for imaging examination?

intraoral PAs

when does pano help?

if the lesion extent is beyond the borders of PA

when may CBCT be used?

if more severe condition beyond periapical inflammatory disease is suspected

what are some notable radiographic features of early periapical inflammatory disease?

• little change

• d/x mainly based on pulp vitality tests or clinical

what are some notable radiographic features of late periapical inflammatory disease?

• lamina dura becomes less distinct and PDL widens (PARL)

• radiolucency at apex

• diffuse surround area of radiopacity

WHERE does periapical inflammatory diseases occur?

• around apex

• epicenter is near tooth apex

  • moves apically away as lesion grows

how might the PERIPHERY appear with periapical inflammatory disease?

• poorly to moderately well defined

• smooth, hydraulic contour

• radiolucency has radiopaque periphery

• rarely well defined, corticated with a narrow zone of transition

what might cause you to miss early changes?

masking by anatomic superimposition; zygomatic for example

what are some surrounding structure effects?

1. sclerosis

2. cortical erosion

3. periosteal new bone formation

4. odontogenic mucositis

5. adjacent tooth resorption or hypercementosis

what may sclerotic bone reaction include?

• thicker than normal trabeculae

• increase in # of trabeculae / unit area

what does the reduction in marrow spaces cause (sclerosis)?

reduction of local blood supply

what is the periosteal reaction caused by periapical inflammatory disease?

when it extends to a bone border…

• erodes the bone surface

• stimulates periosteal new bone formation

what does the periosteal new bone formation (periosteal rxn) look like?

halo pattern near sinus; onion skin pattern at outer cortical bone surface

what are the effects these periapical inflammatory lesions can cause on adjacent teeth?

• mirrors response of bone

• external resorption

• hypercementosis

• deciduous teeth may be displaced or disrupted

what is your differential diagnosis for these apical lesions?

• periapical or radicular cyst

• periapical granuloma

• normal anatomy

• dense bone island

• other pathology

  • PCOD

  • cancer

what is periapical cemento-osseous dysplasia PCOD?

a benign, non-neoplastic bone lesion that typically affects the periapical region of the mandible

what does a dense bone island look like?

mimics sclerosing osteitis, normal PDL space, sometimes root resorption, vital tooth tests

difference of dense bone island and sclerosing osteitis?

transition zone; DBI has a narrow zone and SO has a wide zone

how to differentiate a cyst or granuloma?

biopsy! epithelial lining of cyst

cannot distinguish radiographically therefor call it rarefying osteitis

what are possible causes of a radiolucent lesion at the apex of a RCT treated tooth?

• persistent or recurrent inflammatory disease

• periapical scar (asymptomatic)

• healing (compare image over time)

what is the initial management of periapical inflammatory diseases?

1. perform vitality test

2. identify etiology

3. compare to prior radiographs and follow up

what is periodontal disease?

inflammatory response to bacteria