Periapical Lesions and conditions of surrounding tissues

Periapical Lesions and Conditions of Surrounding Tissues

• Periapical lesions include periapical granuloma, periapical cyst, and periapical abscess.

• Periapical granuloma is a mass of inflamed granulation tissue caused by microorganisms and their toxic products from the root canal or apical tissues.

• Periapical granuloma is asymptomatic and associated with a non-vital tooth, and may develop into an abscess or a periapical/radicular cyst.

• Radiographically, periapical granuloma shows variable radiolucency, loss of apical lamina dura, and a radiopaque rim.

• Radicular cyst/periapical cyst is a cyst in the apex of a non-vital tooth with a lining epithelium formed after chronic inflammation, and may become symptomatic when large or with acute exacerbation of inflammation or secondary infection.

• Radiographically, radicular cyst/periapical cyst shows a rounded radiolucency encircling affected tooth apex with loss of lamina dura along adjacent root.

• Periapical abscess is an accumulation of inflammatory cells in the apex of a non-vital or vital tooth caused by necrosis of the pulp or periodontal issues.

• Symptoms of periapical abscess vary, and radiographically, it shows periapical enlargement of the periodontal ligament and an ill-defined periapical radiolucency.

• Drainage of an abscess occurs through the path of least resistance, which may lead to severe conditions such as cellulitis, Ludwig's angina, cavernous sinus thrombosis, or osteomyelitis.

• Ludwig's angina is a cellulitis in the submandibular region caused by an acute disseminated infection of a lower molar that disseminates through the neck, and can cause respiratory obstruction, fever, and tachycardia.

• Cavernous sinus thrombosis is a thrombosis of the cavernous sinus that forms a cavity containing vital structures, and can cause periorbital edema, vision loss, and brain abscesses.

• Osteomyelitis is a severe inflammatory and infectious process in the medullar spaces/cortical surface of the bone that can originate from an infectious or non-infectious process, and may lead to acute or chronic suppurative osteomyelitis with bone sequestrum and fracture.Overview of a Benign Bone Condition in the Mandibular Molar Area

• The condition is of unknown cause and is a focal reaction of bone.

• It can be caused by inflammatory, dysplastic, neoplastic, or systemic processes.

• The condition is benign and does not require treatment.

• This bone condition is seen in 90% of cases in the area of the first mandibular molar.

• Most cases are asymptomatic, meaning there are no symptoms.

• Radiographically, the condition appears as a well-defined, round radiopacity.

• The radiopacity is not associated with the tooth.

• The exact prevalence of this bone condition is unknown.

• The condition is typically diagnosed through radiographic examination.

• Differential diagnoses may include cementoblastoma, osteoma, and osteosarcoma.

• It is important to differentiate this benign condition from malignant tumors.

• Further evaluation and follow-up may be necessary depending on the individual case.