Inside resorption
Etiology
• inflammation of the pulp (pulpitis chronica or granulomatosa clausa, Palazzi's granuloma)
• immune cells in the granulation tissue and dentinoclasts break down the inside dentin
Symptom
• asymptomatic purple patch on the crown
Process
• Progressive
Clinical appearance
• pink discoloration
Sensitivity test
• response similar to the intact tooth
• in general, it will retain their vitality
Dr. Herczegh Anna PhD
Department of Restorative Dentistry and Endodontics
associate professor
Inside resorption
Rtg
• Radiolucens laesio inside the root
Treatment
• Rootcanal treatment ( rapidly)
• Warm gutta-percha technique, MTA
Dr. Herczegh Anna PhD
Department of Restorative Dentistry and Endodontics
associate professor
Pulp calcificatio
Etiology
• Advancing age
• Persistent stimuli (eg. caries) calcification
• Secondary dentin formation →the cavity system narrows
• At the end of the root cement apposition → foramen apical narrowing
• reduction in amount of blood flow →arteriosclerotic changes
• The number→ of cellular elements is decreasing → collagen bundles can be detected → pulp
fibrosis
• number of blood vessels and nerves decreasing → dentin permeability↓
Symptom
• Asymptomatic
Process
• Progressive
Clinical appearance
• the crown may be discolored ( yellowish)
Sensitivity test
• No response for stimuli or reduced
Dr. Herczegh Anna PhD
Department of Restorative Dentistry and Endodontics
associate professor
Pulp calcificatio
Rtg
• pulp chamber and root canal narrowing, obstruction
• pulp stones
• calcification metamorphosis
Treatment
• If it is necessery rootcanal treatment
Dr. Herczegh Anna PhD
Department of Restorative Dentistry and Endodontics
associate professor
Differencial diagnosis
Dentin sensitivity
• The pain is similar to reversible pulpitis
But the pain is caused by a hydrostatic pressure difference in the dentin which is
mechanically irritates the nerve endings
Irreversible pulpitis
• need to be allocated from periapical inflammation
• in case of apical periodontitis there is axial percussion sensitivity
• in case of periapical abscess there is fistula
• the apical processes in general there are also x-ray findings
Sinusitis
thermal and electrical pain stimuli can not elicit in tooth
typical symptoms of sinusitis are present: pain when you drive forward the head
and pressure cause pain in the front wall of the maxilla
Unlocalizable pain
separation from: jaw, neuralgic pain, otitis media, osteomyelitis, inflammation of
the parotid
Dr. Herczegh Anna PhD
Department of Restorative Dentistry and Endodontics
associate professor
Periodontal diseases
Dr. Herczegh Anna PhD
Department of Restorative Dentistry and Endodontics
associate professor
Acute apical periodontitis
Etiology
• Pulp necrosis
• Pulp inflammation reach the periapical tissue
• Endodontic procedure
• Paradontal process
Symptoms
• Intense pain bite on it or touch to biting
• inflammation→edema fluid → pressure on the nerve
• Elongation (feeling)
Process
• Depends from virulence and exposure time
• Stronger infection than the body’s defenses→ intense acute inflammation
• Increased edema fluid → pain
• Untreated case→abcessus
Dr. Herczegh Anna PhD
Department of Restorative Dentistry and Endodontics
associate professor
Acute apical periodontitis
Sensitivity test
• Cold –
• Warm can be+
Palpation: the tooth can be movable
Percussion: Intense pain Do not use it !!!
Rtg
• Negative
• Root membrane gap widening ( after10-12 days)
• Positive, after chronic inflammation : resorption bone defense
Treatment
• Reduce occlusion
• Root canal treatment ( open???? close?????) 2 sites
Dr. Herczegh Anna PhD
Department of Restorative Dentistry and Endodontics
associate professor
Chronic apical periodontitis
Etiology
• Permanent presence of moderate virulence bacteria
• Untreated pulp necrosis
• Incomplete rootcanal treatment (dead space)
• Periodontitis apicalis acuta
Symptom
• Discomfort for biting
Process
• Chronical inflammation → reabsorption of lamina dura and spongiest asymptomatic or
mild discomfort
Sensitivity test
• Cold- , electrical stimulus-
• Warm: can be + ( closed tooth)
Palpation, Percussion: can cause sensitivity
Dr. Herczegh Anna PhD
Department of Restorative Dentistry and Endodontics
associate professor
Chronic apical periodontitis
Rtg
• Destruction of periapical tissues
Histology
• Granulomatic tissue + macrophag, histiocyta plasma cell
• Cyst: eosinophil fluid multilayered epithelium, connective tissue,, granulomatic cells
Treatment
• Rootcanal treatment (1 or 2 sites)
Dr. Herczegh Anna PhD
Department of Restorative Dentistry and Endodontics
associate professor
Dr. Herczegh Anna PhD
Department of Restorative Dentistry and Endodontics
associate professor
Dr. Herczegh Anna PhD
Department of Restorative Dentistry and Endodontics
associate professor
Acute apical abscess
Etiology
• Flare-up of a chronic process - the body reacts severely to irritativ factors from
necrotized pulp. It rarely develops from an acute process.
Symptoms
• Pain, systemic manifestation (fever, malaise, leukocytosis)
Process
• Inflammation leads to abscess → melts or spreads diffusely in the periapical space.
Sensitivity test
• No response to heat and electrical stimuli
Palpation
• The tooth may become loose, swelling
Percussion
• Intense pain, forbidden to use it
Dr. Herczegh Anna PhD
Department of Restorative Dentistry and Endodontics
associate professor
Abscessus apicalis acuta
Rtg
• Thickened ,widened root membrane gap, then a picture typical of chronic apical
periodontitis.
Histology
• Abscess PMN leukocyte
• Granulomatous tissue
• Purulent exudate
Treatment
• Drainage
• Rootcanal treatment (Closing in 2 sessions?????)
• Antibiotic
• Oral surgeon
Dr. Herczegh Anna PhD
Department of Restorative Dentistry and Endodontics
associate professor
Chronic apical abscess (periodontitis apicalis
suppurativa)
Etiology
• abscess formation after pulp necrosis or periodontitis apicalis chronica
Symptoms
• fistula → drainage → no pain
Process
Chronic apical abscess →fistula,
parulis
Dr. Herczegh Anna PhD
Department of Restorative Dentistry and Endodontics
associate professor
Chronic apical abscess (periodontitis
apicalis suppurativa)
Sensitivity test
• no response to heat and electrical stimuli
Rtg
• Similar to chronic apical periodontitis
Histology
• Similar to chronic apical periodontitis + fistula
Treatment
• Rootcanal treatment (1 site)
Dr. Herczegh Anna PhD
Department of Restorative Dentistry and Endodontics
associate professor
Condensing osteitis
Etiology
• Inflammation spreads into the root membrane gap
• Pulp necrosis or irreversible pulpitis cause it
• Persistent minor infection, mild toxin effect →local defense mechanism reduces
inflammation
Symptom
• Asymptomatic, discomfort
Process
• Inflammation → Increased osteoblast activity → hyperossification
Sensitivity test -
Percussion -
Dr. Herczegh Anna PhD
Department of Restorative Dentistry and Endodontics
associate professor
Condensing osteitis
Rtg
• Irregular, diffuse, concentric radiopaque bone around the root apex, hyperossificacio
• It most often develops around the roots of lower molar teeth.
Histology
• Irregular bone structure
Treatment
• Rootcanal treatment
Dr. Herczegh Anna PhD
Department of Restorative Dentistry and Endodontics
associate professor
Differencial diagnosis
Anatomical formulas:
• canalis mandibulae, foramen mentale, sinus maxillaris, foramen incisivum,
Benign lesions that do not originate from the periodontium:
• cementoma, monostaticus fibroticus
• dysplasia, traumatic bone cyst, ameloblastoma,
• central hemangioma
Malignant lesions not originating from the dental pulp:
• chondrosarcoma, myeloma
Dr. Herczegh Anna PhD
Department of Restorative Dentistry and Endodontics
associate professor