3. Normal periapical tissuesNormal periapical tissues
No pain al allNo pain al all
Not be abnormally sensitive to percussionNot be abnormally sensitive to percussion
or palpation testingor palpation testing
Normal intact lamina duraNormal intact lamina dura
Normal PDLNormal PDL
4. Symptomatic apicalSymptomatic apical
periodontitisperiodontitis
painful inflammation of periodontiumpainful inflammation of periodontium
through root canal, regardless of whetherthrough root canal, regardless of whether
tooth is vital or non-vitaltooth is vital or non-vital
Result:Result:
trauma,trauma,
irritationirritation
infectioninfection
5. ETIOLOGYETIOLOGY
IN VITAL TEETH
- Abnormal occlusal contacts
over occlual plan restoration
foreign object between the teeth
Trauma
6. IN NONVITAL TEETHIN NONVITAL TEETH
Sequelae of pulpal diseases,
Iatrogenic
root canal instrumentation
foramen Forcing of irrigating irrigants
Extension of obturating material
Perforation of the root
overinstrumentation during cleaning &
shaping of root canals.
7. Signs and SymptomsSigns and Symptoms
Tender on percussion
Dull, throbbing and constant pain
pain on closure and mastication.
Negative or delayed vitality test
Cold may relieve pain
Radiographically, widening of the pdl
space
8.
9. Treatment
Treatment If tooth in hyper occlusion,
relieve occlusion
If tooth infected, initiate endodontic
therapy
13. SIGNS AND SYMPTOMSSIGNS AND SYMPTOMS
Does not respond to vitality test
Percussion no pain Slight sensitivity to
palpation
Radio graphically interruption in lamina
dura Destruction of periapical tissues