Periapical Lesions
Inflammatory periapical lesions can be confusing in some aspects due to the lack of pathognomonic radiological images, able to characterise the different pathological entities, and the lack of clinical verification which often characterises the orthopanto
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Periapical Lesions
Inflammatory periapical lesions turn out to be complex and can be confusing in some aspects, also for the experts. This is mainly due to the lack of pathognomonic radiological images, able to characterise the different pathological entities, and the lack of clinical verification which often characterises the OPT radiological reports. Indeed, there is no doubt that the possibility of having clinical functional information at disposal (sensitivity tests, anamnestic confirmation, etc.) can be the key factor in precisely marking out the radiological images, which often are nonspecific. On the basis of what is mentioned above, it is evident that, in the (very frequent) case of the evaluation of the radiological images in a context lacking of clinical information, the radiologist has to describe the picture accurately, without employing terms which subtend complex pathological realities (e.g. apical granuloma, acute periapical abscess), but describing only elementary alterations (interruption of the lamina dura, periapical lytic lesion, perialveolar osteosclerosis, etc.).
Nosography of Inflammatory Periapical Lesions As explained above, even if in the majority of cases, the radiological image is to be considered as nonspecific, a brief nosologic overview of the topic seems to be useful (also in order to use a correct terminology). Alterations of the periapical tissues can be triggered by inflammatory phenomena of endodontic or periodontal origin (Figs. 5.1a, b and 5.2a, b). In the first case, the infectious process reaches the periapical region following alterations in the dental pulp, which in turn are caused by penetrating caries or by conditions which cause the contamination of the endodontic content (incongruous treatments, traumatic lesions, etc.) Conversely, in the second eventuality, the periapical lesion derives from an infection of the periodontal space which represents a predetermined pathway of diffusion (this topic will be treated more extensively in the following chapter). I. Pandolfo, S. Mazziotti, Orthopantomography, DOI 10.1007/978-88-470-5289-5_5, © Springer-Verlag Italia 2013
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Periapical Lesions
From the clinical point of view, periapical alterations can be classified as acute, subacute and chronic. Acute alterations are a consequence of oedematous or necrotic pulpitis, which in most cases, will not give rise to any radiologically recognisable modification. Conversely, if the pathological process goes further forward, acute periapical abscess originates. This last, if correctly and promptly treated, can evolve towards healing. Otherwise it can be characterised by a torpid and prolonged course (subacute periapical abscess and chronic periapical abscess). In this case it is followed by possible complications (fistulisation, osteomyelitis, apicolysis, etc.). Further evolution of the lesion will gradually lead to its progression, with extended destructive phenomena of the alveolar cancellous bone (chronic alveolitis). These may or may not be associated to reactive sclerosis
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