this seminar is talking about one of the most important topics for any dentist in the world (pulp and periapical diseases)
i hope it will be helpful for you
2. Introduction
Structure & function of the dentin
pulp complex
Inflammation & histopathology of
inflammation
Pathways of the pulp & etiology of
pulpal pathosis
3. Structure & function of dentin pulp
complex
Dental pulp complex
Dentin structure
&Permeability
Dental pulp :
(histology ,function &
special environment)
26. PROGRESSION OF PULPAL
PATHOSIS
Bacteria +Byproducts in deep layers of Dentin
Pulp is affected by bacterial byproducts before actual bacterial invasion
(via exposed D.T.)
Local cellular invasion
When actual exposure occurs, pulp is locally infiltrated with PMNs
Followed by liquefaction necrosis at site of exposure
Eventually necrosis spreads all across pulp then if not treated to periapical
tissues
27. CLASSIFCATION OF DISEASES
OF THE PULP
Grossman’s Clinical
Classification
Pulpitis
Reversible Irreversible
Acute Chronic
Pulp
Degeneration
Pulp Necrosis
28. Inflammatory diseases of the pulp
according to
Severity & duration:
i) Acute ii) Chronic iii)Subacute
Presence or absence of symptoms:
i)Symptomatic ii)Asymptomatic
Ability to heal:
i)Reverible ii) Non reversible
29. 1-Inflammatory diseases of the pulp
(Pulpitis)
A- HYPERALGESIA- HYPERSENSITIVITY- REVERSIBLE PULPITIS-
HYPERSENSITIVE DENTIN-HYPEREMIA- HYPERACTVE PULPALGIA
B – IRREVERSBLE PULPITIS
a) SYMPTOMATIC PULPITIS :PAINFUL PULPITIS: ACUTE PULPITIS
b) ASYMPTOMATIC PULPITIS: NON PAINFUL PULPITIS:
CHRONIC PULPITIS-
i. CHRONIC ULCERATIVE PULPITIS
ii. CHRONIC HYPERPLASTIC PULPITIS
iii. CLOSED FORM OF CHRONIC PULPITIS
30. A- HYPERSENSITIVITY- REVERSIBLE PULPITIS- HYPERSENSITIVE
DENTIN-HYPEREMIA- HYPERACTVE PULPALGIA
Definition: A clinical diagnosis based on
subjective and objective findings indicating
that the inflammation should resolve and the
pulp return to normal
Etiology:
Histopathology: Range from hyperaemia to
mild to moderate inflammatory changes limited
to the are a of involved D.T., V.D.→ ↑I.P.P.
→ Oedema → W.B.C.s infiltration
→followed by odontoblast differentiation and
reparative dentin formation
31. B – IRREVERSBLE PULPITIS
SYMPTOMATIC IRREVERSBLE PULPITIS :PAINFUL
PULPITIS: ACUTE PULPITIS
Definition: A clinical diagnosis based
on subjective and objective findings
indicating that the vital inflamed
pulp is incapable of healing. (lingering
thermal pain, spontaneous pain,
referred pain)
Etiology:
Histopathology:
32. B – IRREVERSBLE PULPITIS
b) ASYMPTOMATIC PULPITIS: NON PAINFUL PULPITIS:
CHRONIC PULPITIS-
Definition: A clinical diagnosis based on
subjective and objective findings
indicating that the vital inflamed pulp is
incapable of healing. (no clinical
symptoms)
i. CHRONIC ULCERATIVE PULPITIS
ii. CHRONIC HYPERPLASTIC PULPITIS
iii. CLOSED FORM OF CHRONIC PULPITIS
• Etiology:
33. CHRONIC PULPITIS
Examination & diagnosis:
Non painful - mild discomfort
Spontaneous pain
Heat elicits pain
Exacerbation with lowered
body immunity
Delayed reaction to EPT
X - ray may be -ve , internal
resorption or condensing osteitis
34. CHRONIC ULCERATIVE PULPITIS
Chronic inflammation with
abscess formation at the
exposure site, and the
abscess is surrounded by
granulomatous tissues
Examination & diagnosis:
Painful with food impaction
All signs of chronic pulpitis
35. CHRONIC HYPERPLASTIC PULPITIS
Seen in young
permanent cariously
exposed teeth
It is an attempt of
healing and repair by
walling off the irritation
Proliferative reaction of
the pulpal granulation
tissue with formation of
a polyp
May become
epithelialized from
desquamated
epithelial cells
36. PULP NECROSIS
Definition: A clinical diagnostic category in dicating death of the pulp.
The pulp is usually nonresponsive to pulp testing. 2 types are present.
LIQUEFACTIVE
NECROSIS
(WITH GOOD BLOOD SUPPLY.)
COAGULATIVE NECROSIS
(WITH DIMINISHED BLOOD
SUPPLY.)
37. Examination & diagnosis:
If not treated
►►►Periapical leson of
endodontic origin
Usually non painful untill the
periapex is envolved.
Radiographic findings are -ve
unless there is a concomitant
periapical disease.
-Ve with EPT except (some
times) in liquefactive necrosis
&multi rooted teeth.
38. RETROGRESSIVE PULP CHANGES
(Pulp Degeneration)
1 - ATROPHY AND FIBROSIS
Definition: waisting away or decrease in sze of the
pulp, with age.
MAY BE CONSIDERED AS AGE CHANGES.
Histopathology:
Mature collagen incrase / unit area and the cells
deminish in no. And size.
Excessive secondary dentin deposition deminishes the
size of the pulp chamber & canal lumen.
Decrease in blood supply.
40. INTERNAL RESORPTION
ETIOLOGY:
Unknown , often histore of trauma Or chronic pulpitis. Or
pulpotomy
Examination & diagnosis
The pulp is vital .
Delayed response to EPT
In the pulp chamber it forms the pink spot.
In the canal it may perforate causing a lateral lesion.
At the cervical level it may be mixed with external cervical
resorption.
Radiographically,in int. Resorption disrupts the canal while
in ext .Resorption the canal contour is unaltered.
42. SYMPTOMATIC (ACUTE) APICAL
PERIODONTITIS
SYMPTOMATIC (ACUTE) APICAL PERIODONTITIS
Definition: Inflammation of the apical periodontium
producing clinical symptoms including a painful
response to biting and/or percussion . It might or not
be associated with apical radiolucent area.
• Etiology:
• ) Histopathology: (as explained before)Inflammatory
reaction in apical periodontal ligament ? Dilation ob
B.V.? Exudation and accumulation of PMNs
?Distension of P.L. and extrusion of tooth ----with
continuous irritation ---?loss of alveolar bone
• Examination & diagnosis:
• : Treatment : R.C.T----
– TOOTH REDUCTION OUT OF OCCLUSION
43. ACUTE APICAL ABSCESS
: Definition: An inflammatory reaction to pulpal
infection and necrosis characterized by rapid onset ,
spontaneous pain , tenderness to tooth pressure, pus
formation and swelling of associated tissues
• Etiology:
• Histopathology: Inflammatory reaction in apical
periodontal ligament ? Dilation ob B.V.? Exudation
and accumulation of PMNs ?Distension of P.L. and
extrusion of tooth ----with continuous irritation ---?loss
of alveolar bone---- localized area of liquefactive
necrosis containing PMNs , debris , cell remnants and
purulent exudate
44. Examination & diagnosis:
Tooth severely painful & tender
• Localized vestibular swelling or
facial cellulitis• Pain starts
severe and decrease after
swelling
• Patient may become febrile
with lympf nodes affection
• Tooth becomes loose
• -Ve EPT findings except in
liquefactive necrosis & multiple
canals
• Radiograph: HAZY APICAL
RAREFACTION
45. RECRUDECENT ABSCESS
(PHOENIX ABSCESS)
Definition: ACUTE EXACERBATION OF A PRE- EXISTING
CHRONIC PERIAPICAL PATHOSIS
RECRUDECENT ABSCESS
• Clinically often undistinguishable from AAA
• DIAGNOSIS IS BASED ON PATIENT HISTORY,
CLINICAL PICTURE AND RADIOGRAPHIC
FINDINGS REVEALING THE PREVIOUS
CHRONIC PERIAPICAL PATHOSIS
46. CHRONIC APICAL PERIODONTITIS
Definition::Inflammation of the apical
periodontiumof pulpalorigin, that does not
produce clinical symptoms and
radiographicallyappears as apical R.L. area
Inflammation of the apical
periodontiumof pulpalorigin, that does not
produce clinical symptoms and
radiographicallyappears as apical R.L. area
– asymptomatic or slight discomfort
– little or no pain on percussion
• X-ray:
– apical radiolucency or Condensing
osteitis: radiopaque
47. PULPOPERIAPICAL
OSTEOSCLEROSIS
• Productive response of
periapical bone to a low-grade
long standing pulpal irritation
• Increase in density of bone
due to osteoblastic hyperactivity
• Seen in young permenant
teeth with carious exposures &
chronically inflammed pulps
48. CHRONIC APICAL ABSCESS
(SUPPURATIVE APICAL PERIODONTITIS)
Nonpainful low grade long
standing chronic inflammatory
reaction to pulpal irritants
• It represents a balance between
body resistance and the periapical
pathosis
• Formation of pus that
drainsthrough a sinus tract
• Ill defined periapical
radiolucency
• The tooth may be slightly mobile
49. PERIAPICAL GRAMULOMA
• Examination & diagnosis:
• Non painful• -Ve EPT findings
• Well defined periradicular radiolucency•
Histopathology:
• periapical granulomatous tissue
• Encapsulated with a fibrous capsule
• May show epithelial strands
• May transform into a phoenix abcess if
infected or manipulated
50. PERIAPICAL CYST
Definition::Inflammatory cyst due to extension of
infection from pulp into surrounding periapical
tissues
• Histopathology:
• Central fluid-filled epithelium-lined cavity
surrounded by granulation tissue and a fibrous
capsule
• Forms on heals of a periapical granuloma
• Examination & diagnosis:
• Well defined apical radiolucency
• Non painful untill infected (phoenix abscess)
• Slowly growing destroying bone and moving
teeth