By depertement of dental radiology

PRINSIP UMUMRadiolucent/Radiopaque lession pada apek akarBeberapa lesi periapikal:Awal:radiolusen radiopakPenyebab paling banyak :pulpa nekrosis akibat karies gigiPada diagnosis kelainan periapikal sangat penting untuk menilai vitalitas dari gigi

Periodontitis apikalisPeriapical abscessPeriapical granulomaPeriapical cystFibrous healing defectHipercementosis Focal Sclerosing Osteomyelitis (condensing osteitis)List of disease

JEJAS(fisik, kimia, mikroorganisme) PERMUKAAN GIGI SEHAT /PULPA PULPITIS REVERSIBLE

ASYPMTOMATIS SYMPTOMATISBila tidak dirawat

PULPITIS KRONIS PROLIFERATIF PULPITIS IREVERSIBLEBila tidak dirawat RESORPSI INTERNA NEKROSIS PENY. PERIRADIKULER PERIODONTITIS APIKALIS

ASYMPTOMATIS SYMPTOMATIS ABSES PERIAPIKAL KKRONIS ABSES PERIAPIKAL AKUT GRANULOMA PERIAPIKALKISTA PERIAPIKALSEKEMA PATOGENESIS KELAIANAN PERIAPIKAL AKIBAT KELAINAN PULPA

GAMBARAN RADIOGRAFI PERIAPIKAL YANG PENTING UNTUK ACUAN INTERPRETASI:

Radiolucent line dari periodontal ligament space Normal : Thin continuous black line melingkari akar gigi Radiopaque line dari lamina dura Normal: Thin, continuous. Pola trabekula dan densitas tulang sekitar: - Mandibula: cortec cendrung lebih tebal, trabekula lebih rapat arah horisontal - Maksila:Cortec Lebih tipis, trabekula lebih longgar

Akibat lanjut infeksi pulpa(pulpitis/nekrosis), traumatic occlusion, over instrument/overfilling, bahan irigasi dan sterilisasi SAKlinis :- Gigi vital/non-vital, perkusi , tekanan - Karena pulpitis : peka terhadap dingin, panas dan elektrik - Nyeri saat mengunyah

Radiograf: pelebaran space periodonsium bagian apikal PERIODONTITIS APIKALIS AKUT (PAA)

Sinonym: apical periodontal abscess 1,1 % dari kelainan periapikal radiolusen Etiology 1. Acute inflamatory process containing neuthrophils and necrotic debris (pus) 2. Develops at the root apex of the pulp necrotic Typical Radiographic Features: - Cirkumscribed radiolucent at the root apex, berbatas difuse - Kontinuitas lamina dura terputus - Occasionally : be displaced laterally - The tooth show: deep caries, large restoration or endodontic theraphyPERIAPIKAL ABSCESS ........

Clinical : - Asymptomatic, - nonvital - perkussion : painful - advance : fistula Differential DiagnosisPeriapical Granuloma Periapical CystFocal sclerosing osteomyelitis (early lession)Periapical cemento-osseus dysplasia

Clinical Significance Untreated Ostemyelitis

Sinonym : Chronic apical periodontitis adalah pembentukan jaringan granulasi sebagai respon pertahanan terhadap infeksi periapikal yang tidak dirawat 48% kelainan periapikal yang radiolusen Dapat terjadi transformasi kistik Clinical : - Gigi non-vital - Asymptomatic - Percussion, tekanan : not be painfulPERIAPICAL GRANULOMA

Typical Radiographic Feature: - Cirkumscribed radiolucent at the root apex, distinc border - Kontinuitas lamina dura terputus - Occasionally : be displaced laterally - The tooth show: deep caries, large restoration or endodontic theraphy

DD/: 1. Periapical abscess 2. Periapical cyst 3. focal sclerosing osteomyelitis (early lession) 4. Periapical cemental dysplasia 5. Simple bone cyst Clinical Significance acute exacerbation Periapical abscess

Sinonym: radicular CystEtiology: The odontogenic epithelium originates from the rest of malassez 43% kelainan periapiakClinical: - The tooth: nonvital, - Asymptomatic, - Percussion&tekanan: not be painful

PERIAPICAL CYST.

Typical Radiographic Features ; - Cirkumscribed radiolucent at the root apex, distinc border with radiopaque lining margin - Kontinuitas lamina dura terputus - Occasionally : be displaced laterally - The tooth show: deep caries, large restoration or endodontic theraphy

DD/: 1. Abses periapikal 2. Granuloma periapikal 3. Periapical cemental dysplasia (early lession) 4. focal sclerosing osteomyelitis (early lession) 5. Simple bone cyst

adalah lesi diperiapikal akibat tindakan kuretase pd perawatan apek reseksi terjadi ruang kosong Klinis : gigi non vital Radiographic features : - Radiolusen lebih pekat bulat / oval pada apikal - Akar gigi Ada bekas pemotongan - Retrograde restorationFIBROUS HEALING DEFECT .

FOCAL SCLEROSING OSTEOMYELITIS (initially lession) Syinonim - Condensing Osteitis - Focal chronic Sclerosing Osteomyelitis - Sclerosing Osteitis/Bone Scllerotic Etiology Inflamation (Chronic osteomyelitis) that develops at the root apex of toot with chronic pulpitis Clinical - The most common in mandibular premolar or molar - Asymptomatic, or chronic pain of low intensity

Typical Radiogrphic Feature Cirkumscribed radiolucent at the root apex with a deep caries lession

Clinical Significance With time calcified radiopaque appearanceEARLY LESSIONADVANCE LESSION

terjadi karena produksi sementum yang berlebih akibat respon peradangan periapikal dapat terjadi karena beberapa faktor etiologi Sering ditemui secara insidental (tidak sengaja) pada pem. radiografi Sering pada Px tua radiograf; - Pembesaran apikal gigi seprti bola lampu / alat pemukul (clubbing root end) - Kadang outline asli akar masih dapat diamati dalam masa hipersementosis tersebut - Lamina dura dan space periodonsium masih utuh dan jelas - Gigi supra erupsiHIPERCEMENTOSIS