32 Questions
What is a periapical granuloma?
A mass of chronically or subacutely inflamed granulation tissue at the apex of a nonvital tooth in response to chronic inflammation
What may periapical granuloma progress to?
Periapical cyst formation or phoenix abscess due to changes in pulp infection
What do neutrophils produce in the later stage of periapical granuloma?
Prostaglandins that activate osteoclasts to resorb bone
What are the clinical features of chronic periapical granuloma?
Generally asymptomatic with variable radiographic changes
What is the recommended treatment for alveolar osteitis (dry socket)?
Socket irrigation with normal saline
What are the risk factors associated with the development of alveolar osteitis (dry socket)?
Tobacco use and inadequate postoperative care
What characterizes the appearance of the affected extraction site in alveolar osteitis (dry socket)?
A dirty gray clot that is lost, leaving a bare bony socket
What symptom is less frequently associated with alveolar osteitis (dry socket)?
Bleeding from the extraction site
What is a common symptom of acute apical periodontitis?
Throbbing pain
What is a characteristic feature of periapical granuloma?
No response to vitality testing
What treatment is aimed at reducing the microbial load in endodontics?
Root canal treatment (RCT)
What is the histopathologic feature of periapical granuloma?
Inflamed granulation tissue surrounded by a fibrous connective tissue wall
What is the characteristic feature of a periapical cyst?
Lumen containing fluid and cellular debris
What is the recommended follow-up period after root canal treatment (RCT) for periapical granuloma?
1-2 years
What is the significance of the quality of coronal restoration in root canal treatment (RCT)?
High importance for treatment success
What is the recommended treatment for symptomatic cases of periapical granuloma?
NSAIDs
What is the characteristic feature of periapical granuloma?
Presence of chronically or subacutely inflamed granulation tissue at the apex of a nonvital tooth
What do neutrophils produce in the later stage of periapical granuloma?
Prostaglandins that activate osteoclasts to resorb bone
What may periapical granuloma progress to?
Periapical cyst formation
What are the clinical and radiographic features of acute apical periodontitis?
Symptomatic with radiographic alterations
What is the recommended initial treatment for alveolar osteitis (dry socket)?
Socket irrigation with normal saline
What can lead to the development of alveolar osteitis (dry socket)?
Tobacco use
What characterizes the appearance of the affected extraction site in alveolar osteitis (dry socket)?
A dirty gray clot that is lost, leaving a bare bony socket
What symptom is less frequently associated with alveolar osteitis (dry socket)?
Fever
What is the characteristic histopathologic feature of periapical granuloma?
Inflamed granulation tissue surrounded by a fibrous connective tissue wall
What is the goal of endodontic treatment for periapical granuloma?
To reduce the microbial load
What is the recommended follow-up period after root canal treatment (RCT) for periapical granuloma?
1-2 years
What is the characteristic feature of a periapical cyst?
Fibrous connective tissue wall lined by epithelium with a lumen containing fluid and cellular debris
In chronic periapical granuloma, what happens to the associated symptoms?
Diminish
What is the significance of the quality of coronal restoration in root canal treatment (RCT)?
It is of high importance
What is the recommended treatment for symptomatic cases of periapical granuloma?
NSAIDs
What may periapical granuloma progress to if the acute inflammatory process evolves into a chronic pattern?
Periapical cyst
Study Notes
Periapical Granuloma
- A periapical granuloma is a chronic inflammatory reaction at the apex of a tooth root.
- It may progress to a periapical cyst or a periapical abscess.
- In the later stage, neutrophils produce enzymes that break down the surrounding tissue.
- Characteristic features of periapical granuloma include a chronic inflammatory reaction, fibrovascular tissue, and a mixture of acute and chronic inflammatory cells.
Clinical Features of Chronic Periapical Granuloma
- Associated symptoms, such as pain and swelling, decrease over time.
- Radiographic features may include a radiolucent area at the apex of the tooth.
Alveolar Osteitis (Dry Socket)
- Recommended treatment is pain management, irrigation, and dressing of the socket.
- Risk factors include traumatic extraction, poor oral hygiene, and smoking.
- The affected extraction site appears empty, with a whitish or yellowish material at the base.
- Less frequent symptom is fever.
- The condition can develop due to bacterial contamination, food impaction, or trauma to the socket.
Acute Apical Periodontitis
- Characteristic feature is a sudden, severe pain.
- Clinical and radiographic features include pain, swelling, and a radiolucent area at the apex of the tooth.
Endodontic Treatment
- Goal is to reduce the microbial load.
- Recommended treatment for symptomatic cases of periapical granuloma is root canal treatment (RCT).
- Significance of the quality of coronal restoration in RCT is crucial to prevent further infection.
- Recommended follow-up period after RCT is 6-12 months.
Periapical Cyst
- Characteristic feature is a sac-like structure containing fluid and lined with epithelium.
Histopathology
- Characteristic feature of periapical granuloma is a mixture of acute and chronic inflammatory cells.
- Histopathologic feature of periapical granuloma is a chronic inflammatory reaction with fibrovascular tissue.
Test your knowledge of periapical cysts with this quiz on clinical and radiographic features, diagnosis, and common symptoms. Identify key characteristics and learn more about this dental condition.
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