pathology of the pulpal and periradicular tissues 2012 2013
DESCRIPTION
The lecture describes the pathology of pulp dan periraducular tissues and the factors which affect the response of the pulp and periradicular area.TRANSCRIPT
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Endodontics DB 305C Module 1 Year 3. Wan Noorina WA
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¡ Explain the scope of endodontic treatment ¡ Explain why root canal treament needs to be carried out
¡ Describe the stages of root canal treatment ¡ Describe the standards of treatment ¡ List the factors that determine the success of treatment
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¡ Characterize aetiological factors causing pulpal inflammation
¡ Explain the mechanism of spread of inflammation in the pulp and periradicular tissues and its consequences
¡ Explain why the pulp has difficulty in recovering from severe injury
¡ Classify the pulpal and periradicular lesions ¡ Describe the step involve in healing(resolution) of
periradicular lesions following successful root canal treatment
¡ Identify in general, non-‐endodontic lesions that may simulate endodontic periradicular lesions
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¡ The study of form, function and health of:-‐
¡ Injuries to and diseases of dental pulp and periradicular region
¡ The prevention ¡ The treatment management
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¡ The clinical management that consists of procedures that are design to maintain the health of all or part of dental pulp
¡ When pulp is diseased or injured, treatment aimed at preserving the normal periradicular tissues
¡ When infection pursues, treatment is aimed at restoring the periradicular tissues to health
¡ This is done with root canal treatment, + surgical endodontics
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Healthy pulp
Inflamed
Pulpectomy Root canal treatment (Preserving The Normal Periradicular Tissues)
Maintain health
Infected
Pulp capping Pulpotomy
Root canal treatment Root canal re-‐treatment Apical surgery (Restoring The Periradicular Tissues To Health)
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WHY?
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¡ Living organisms § Micro-‐organisms ▪ Bacteria ▪ Viruses ▪ ? Others
¡ Non-‐living irritants § Mechanical § Thermal § Chemical
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¡ Kakehashi et al. The effects of surgical exposures of dental pulps in germ-‐free and conventional laboratory rats. Oral Surg Oral Med Oral Pathol 20:340; 1965
¡ Moller et al. Influence on periapical tissues of indigenous oral bacteria and necrotic pulp tissue in monkeys. Scant J Dent Res 89:475, 1981
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¡ Microorganisms § Toxins § By products
¡ Pulp is infiltrated at the base of the carious tubules by
§ Chronic inflammatory cells § Macrophages, lymphocytes § Plasma cells
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¡ Once pulp is exposed, pulp is infiltrated by PMN to form liquefaction area at the site of exposure
¡ Bacteria colonize and
persist at the site
¡ Pulp tissue will § Remain inflamed for a long
time or § Undergo necrosis slowly or
rapidly ¡ Depending on
§ Bacteria virulence § Ability to release
inflammatory fluids § Host § The amount of circulation § Lymph drainage
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¡ By this time pulp harbors bacteria and by-‐products.
¡ Pulp can only defend temporarily to impede the spread of infection and tissue destruction
¡ More irritantàmore damage and will spread throughout pulp
¡ Subsequently bac, toxins & by-‐products will diffuse periapicallyàapical inflammatory lesions
¡ Where is the bacteria?
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§ Cavity prep (physical) § Cavity prep without water (physical with thermal) § Physical pressure on the prepared tooth (physical) § Deep periodontal curettage (physical) § Occlusal trauma (physical) § Orthodontic movement (physical) § Dentine expose § Dental materials ▪ Restorative materials ▪ Cements
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IEJ 42, 422-‐444, 2009
Chemical irritants? Leakage?
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¡ Mixed pulpal response to Dycal after 3 months. CP (restorative material along with Dycal) C: Distinct but incomplete hard tissue bridge (BR), revealing gaps on either side of BR with infiltrate of chronic inflammatory cells
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¡ Who can survive after an injury? ¡ Type of injury
¡ The condition of the pulp ¡ Tissue involve
§ Pulp tissue
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¡ Initial response § Hard tissue formation § Examples? § How?
¡ Moderate to severe response § Inflammatory process § Non specific inflammatory mediators and specific immune reactions
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¡ Direct irritation § Hyper-‐occlusion § Occlusal trauma § Endodontic procedural accidents
§ Overinstrumentation § Overextention of GP ▪ Physical ▪ Chemical
¡ Bacteria?
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31 Jan 2005 16 Apr 2005
25 June 2005
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¡ Healing § Regeneration § Repair
¡ How can you tell? ¡ The aim of RCT is to
remove the irritant within the canal
¡ Healing by repair will take place once the irritant is removed and ‘inflammation’ process for healing will take its course
¡ Immune system will take
its course
¡ Osteoclastic resorption stops resorbing bone.
¡ In healing process,
osteoblast cells will start depositing new bone and deposit new matrix.
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REGENERATION OR REPAIR?
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¡ Normal pulp, Healthy pulp ¡ Reversible pulpitis
§ Symptoms § Treatment
¡ Irreversible pulpitis § Symptoms? Asymptomatic? § Signs-‐ PA? § Treatment § Hyperplastic pulpitis ▪ Chronically inflamed young pulp
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¡ Pulp calcification ¡ Internal resorption
§ Lectures in Year 4
¡ Pulpal necrosis § Symptoms § Test & treatment § Not responsive § PA radiographs= normal
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¡ Normal Periapical tissues ¡ Apical periodontitis
§ Acute ▪ Moderate to severe pain ▪ Tender to palpation ▪ Excruciatingly painful to
percussion ▪ May or may not respond to EPT ▪ PA-‐ Slight widening of lamina
dura § Chronic apical periodontitis ▪ May not be in severe pain ▪ Tender to palpation ▪ Tender to percussion ▪ Not responsive to EPT ▪ PA-‐ apical radiolucency
¡ Apical abscess § Acute apical abscess § Rapid onset, painful § No swelling if confined to
bone, otherwise swelling is positive as collection of pus seeps through path of least resistance: soft tissue
§ Tender to palpation and percussion
§ PA-‐ no lesion, + ve widening, and obvious
§ Chronic abscess ▪ Presented with sinus tract ▪ + PA radiolucency
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ACUTE APICAL PERIODONTITIS
46
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¡ CHRONIC APICAL PERIODONTITIS
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¡ Acute apical abscess
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¡ Chronic Apical Abscess
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¡ Very similar to odontogenic lesions
¡ Must be vigilant ¡ Use tests to guide
§ Clinical findings § Sensibility testing § PA radiographs
¡ Usually response to EPTs
¡ Normal structures ¡ Non odontogenic diseases § Early stage of monostotic fibro dysplasia
§ Ossifying fibroma § Dentigerous cysts § Central giant cell granuloma
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Ameloblastoma
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Periapical cemento-‐osseous dysplasia
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¡ Harty’s, Endodontics in Clinical Practice, BS Chong 2010
¡ Endodontics Principles and Practice T and Walton
Questions?