Periapical tissues
Plan
Reminder
Anatomy
Apical and periapical diseases
Complications
Conclusion
Introduction :
The different elements that make up the periodontium are either a bony structure: alveolar bone; or epithelial: epithelial attachment, or epithelial and connective: the gum, but the only element that has a purely connective structure is the periodontium.
In the dental root there is the radicular pulp; at the end of the root; the pulp cavity communicates with the periapical periodontium by the apical foramen which provides passage to the different vascular-nervous elements which can be the source of several dental disorders.
Apical or periapical diseases :
In pulp inflammation, the final stage is pulp necrosis; the infectious process can subsequently only extend towards the periapical region.
Depending on the intensity of the dental reactions, different lesions can develop: abscess, granuloma, cyst, osteitis, etc.
The evolution of acute apical inflammation towards chronicity: pulpal propagation towards the apex and periapical tissues: acute pulpitis🡺peripaical abscess🡺granuloma 🡺cyst …
Periapical abscess: purulent inflammation located in the periapical periodontal tissue: purulent exudate.
Periapical granuloma: non-specific granulomatous inflammation, circumscribed lesion located at the apex of the tooth.
Radicular cyst: cystic transformation of an apical granuloma.
Apical inflammation: can be periapical; latero-radicular or inter-radicular.
Periapical periodontitis :
Simple or serous following simple or serous pulpitis.
Symptoms: toothache ……..
In X-ray:
Thickening of the periodontal ligament.
Not always an image on dental x-ray.
Periapical dental abscess:
Purulent periapical inflammation.
In radiography: thickening of the periodontium and a periapical radiolucent zone.
Apical granuloma : defense response of periapical tissues with granulation tissue component; well-defined, rounded radiolucent lesion.
Radicular cyst : transformation of the pari-apical granuloma into a cystic cavity.
In the form of a well-limited radiolucent image, of variable size, single or multiloculated.
However, the diagnosis of granuloma and radicular cyst cannot always be established until there is an anatomo-pathological examination.
Condensing osteitis : a bone sclerosis reaction with inflammation may occur around the granuloma.
Osteosclerosis : sclerosis of the bone around the apex without inflammation.
Resorption : resorption of bone around the apex due to the apical lesion.
Hypercementosis.
Complications of periapical diseases:
The oral cavity is an important source of pathogenic bacteria: pulp necrosis and pulpitis can constitute active foci and can spread the infection through the locoregional or distant lymphatic and blood tissues requiring rapid diagnosis and treatment.
Acute periostitis : purulent or suppurative; develops into a subperiosteal abscess.
Perimaxillary abscess : located between the bone and the muscle.
Subcutaneous abscess : cutaneous fistulization.
Mucous fistula .
Fistula in the sinus with sinusitis: the appearance of sinusitis of dental origin depends closely on the proximity of the sinus and the root of the infected tooth.
The periapical infection, after having spread into the alveolar bone, can then extend to the surrounding tissues and cause acute inflammatory and edematous reactions: cellulitis or phlegmon .
Osteomyelitis : inflammation of the bone and marrow.
Conclusion
The periapical tissues contain anatomical elements which, in the event of a pathological process, can be the site of several dental disorders.
The different lesions vary from acute inflammation to chronic stage.
Radiological aspects may be typical but in certain cases requiring clinical , biological and anatomo-pathological correlation .
Periapical tissues
Early cavities in children need to be treated promptly.
Dental veneers cover imperfections such as stains or cracks.
Misaligned teeth can cause difficulty chewing.
Dental implants provide a stable solution to replace missing teeth.
Antiseptic mouthwashes reduce bacteria that cause bad breath.
Decayed baby teeth can affect the health of permanent teeth.
A soft-bristled toothbrush preserves enamel and gums.