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Chapter 35

Chapter 35. Interpretation of Trauma and Pulpal and Periapical Lesions. Dental Radiography. Questions What changes resulting from trauma or resorption may be observed on dental images? What features of pulpal lesions or periapical lesions may be observed on dental images?

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Chapter 35

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  1. Chapter 35 Interpretation of Trauma and Pulpal and Periapical Lesions

  2. Dental Radiography • Questions • What changes resulting from trauma or resorption may be observed on dental images? • What features of pulpal lesions or periapical lesions may be observed on dental images? • What is the appearance of crown, root, and/or jaw fractures on dental images?

  3. Dental Radiography • Chapter 35 Reading • Iannucci & Howerton (pp. 426-436)

  4. Dental Radiography • Chapter 35 Outline • Interpretation of Trauma and Pulpal and Periapical Lesions • Trauma viewed on dental images • Resorption viewed on dental images • Pulpal lesions viewed on dental images • Periapical lesions viewed on dental images

  5. Introduction • Iannucci & Howerton (pp. 426) • Purpose • To provide a brief overview of the common features of trauma and pulpal and periapical lesions as viewed on dental images

  6. Trauma Viewed on Dental Images • Fractures • Injuries

  7. Trauma Viewed on Dental Images • Iannucci & Howerton (pp. 426-427) • Trauma • Trauma is an injury produced by an external force. • It may affect the crowns and roots of teeth as well as alveolar bone. • It may result in injuries of teeth and bone and injuries such as intrusion, extrusion, and avulsion.

  8. Fractures • Iannucci & Howerton (p. 427) • The breaking of a part • May affect the crowns and roots of teeth or the bones of the maxilla or mandible • Includes • Crown fractures • Root fractures • Jaw fractures

  9. Crown Fractures • Iannucci & Howerton (p. 427) (Fig. 35-1) • This most often involves anterior teeth. • May involve enamel, dentin, and/or pulp. • The dental image permits evaluation of the proximity of the damage to the pulp chamber and for evaluation of the root for any additional fractures.

  10. Root Fractures • Iannucci & Howerton (p. 427) (Fig. 35-2) • Root fractures most often occur in the maxillary central region. • They may be vertical or horizontal, single or multiple. • If the x-ray beam is parallel to the plane of the fracture, it will appear as a radiolucent line. • If the x-ray beam is not parallel to the plane of the fracture, it may not be apparent at all.

  11. Jaw Fractures • Iannucci & Howerton (pp. 427-428) (Fig. 35-3) • Jaw fractures are most often observed in the mandible. • The panoramic image is the best film for visualizing mandibular fractures. • On a dental image, the fracture appears as a radiolucent line. • Maxillary fractures are typically difficult to detect on dental images.

  12. Injuries • Iannucci & Howerton (pp. 427-428) • Trauma may cause the displacement of teeth. • Displacement involves luxation and avulsion.

  13. Luxation • Iannucci & Howerton (p. 428) (Figs. 35-4, 35-5) • Luxation is the abnormal displacement of teeth. • Intrusion is the abnormal displacement of teeth into bone. • Extrusion is the abnormal displacement of teeth out of bone.

  14. Avulsion • Iannucci & Howerton (p. 428) (Fig. 35-6) • Avulsion is the complete displacement of a tooth from alveolar bone. • The periapical image shows a tooth socket without a tooth .

  15. Resorption Viewed on Dental Images • External Resorption • Internal Resorption

  16. Resorption Viewed on Dental Images • Iannucci & Howerton (pp. 428-429) (Fig. 35-7) • Physiologic resorption • A process seen with the normal shedding of primary teeth • Pathologic resorption • A regressive alteration of tooth structure observed when a tooth is subjected to abnormal stimuli • May be • External resorption • Internal resorption

  17. External Resorption • Iannucci & Howerton (p. 429) (Fig. 35-8) • Seen along the periphery of the root surface • This is often associated with reimplanted teeth, abnormal mechanical forces, trauma, chronic inflammation, tumors and cysts, impacted teeth, or idiopathic causes. • It most often involves the apices of teeth. • The apical region appears blunted. • The length of the root is shorter than normal.

  18. Internal Resorption • Iannucci & Howerton (pp. 429-430) (Figs. 35-9, 35-10) • Internal resorption occurs within the crown or root of a tooth. • Involves the pulp chamber, pulp canals, and surrounding dentin. • It is believed to be precipitated by factors such as trauma, pulp capping, and pulp polyps. • It appears as a round-to-ovoid radiolucency in the midcrown or midroot portion of the tooth. • Endodontic therapy is recommended if perforation has not occurred.

  19. Pulpal Lesions Viewed on Dental Images • Iannucci & Howerton (p. 429) • Examination of the pulp chambers and canals is impossible without dental images. • Dental images may detect conditions such as • Pulpal Sclerosis • Pulpal Obliteration • Pulp Stones

  20. Pulpal Sclerosis • Iannucci & Howerton (pp. 429-430) (Fig. 35-11) • Pulpal sclerosis is diffuse calcification of the pulp chamber and pulp canals of teeth. • Results in a pulp cavity of reduced size. • Is associated with aging. • It is of little clinical significance unless endodontic therapy is indicated.

  21. Pulpal Obliteration • Iannucci & Howerton (p. 430) (Fig. 35-12) • The production of secondary dentin may obliterate the pulp chamber. • These teeth are nonvital and do not require treatment.

  22. Pulp Stones • Iannucci & Howerton (pp. 430-431) (Figs. 35-13, 35-14) • Pulp stones are calcifications found in the pulp chamber or pulp canals. • They appear on dental images as round, ovoid, or cylindrical radiopacities. • They may vary in shape, size, and number. • They do not cause symptoms. • They do not require treatment.

  23. Periapical Lesions Viewed on Dental Images • Periapical Radiolucencies • Periapical granuloma • Periapical cyst • Periapical abscess • Periapical Radiopacities • Condensing osteitis • Sclerotic bone • Hypercementosis

  24. Periapical Lesions Viewed on Dental Images • Iannucci & Howerton (pp. 430-431) • A periapical lesion is located around the apex of a tooth. • It may appear either radiolucent or radiopaque.

  25. Periapical Radiolucencies • Periapical granulomas, cysts, and abscesses are commonly seen on dental images. • These lesions cannot be diagnosed on their dental image appearance alone. • Diagnosis is based on clinical features and dental image and microscopic appearance.

  26. Periapical Granuloma • Iannucci & Howerton (pp. 431-432) (Figs. 35-15, 35-16) • This is a localized mass of chronically inflamed granulation tissue at the apex of a nonvital tooth. • It is the most common sequela of pulpitis. • It may give rise to a cyst or to an abscess. • Treatment is either endodontic therapy or removal of the tooth with curettage of the apical region. • On dental image it appears as a widened periodontal ligament space at the root apex.

  27. Periapical Cyst • Iannucci & Howerton (p. 432) (Fig. 35-17) • Periapical cyst is a lesion that develops over a long period. • It results from cystic degeneration of the periapical granuloma. • It is the most common of all tooth-related cysts. • It is typically asymptomatic. • Treatment is either endodontic therapy or extraction with curettage of the apical region.

  28. Periapical Abscess • Iannucci & Howerton (pp. 432-433) (Figs. 35-18, 35-19) • This is a localized collection of pus in the periapical region of a tooth. • Acute • Painful, nonvital; sensitive to pressure, percussion, and heat • May not appear on dental images • Chronic • Usually asymptomatic; pus drains through bone or the periodontal ligament space • Appears as a round or ovoid apical radiolucency

  29. Periapical Radiopacities • The following are a few of the common periapical radiopacities that may be seen on dental images: • These may be diagnosed based on their appearance, clinical information, and patient history • Condensing osteitis • Sclerotic bone • Hypercementosis

  30. Condensing Osteitis • Iannucci & Howerton (p. 433) (Fig. 35-20) • Condensing osteitis is a well-defined radiopacity. • It is seen below the apex of a tooth with a history of long-standing pulpitis. • May vary in shape and size; does not appear to be attached to the tooth root. • It is the most common periapical radiopacity observed in adults; most commonly in the mandibular third mola.

  31. Sclerotic Bone • Iannucci & Howerton (pp. 433-434) (Fig. 35-21) • Sclerotic bone is well-defined radiopacity seen below the apices of vital, noncarious teeth. • It is of unknown cause. • It is not attached to the tooth. • It varies in size and shape. • Margins may be smooth or irregular and diffuse. • It is asymptomatic.

  32. Hypercementosis • Iannucci & Howerton (pp. 433-434) (Fig. 35-22) • Hypercementosis is the excess deposition of cementum on root surfaces. • May result from supereruption, inflammation, or trauma. • Most often affects the apical area, which appears enlarged and bulbous. • Affected teeth are vital and do not require treatment.

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