Periapical dental radiograph showing chronic periapical periodontitis on the root of the left maxillary second premolar. Note large restoration present in the tooth, which will have undergone pulpal necrosis at some point before the development of this lesion.
Etymologically, the name refers to inflammation (Latin, -itis) around (peri- ) the root tip or apex (-apical) of the tooth (-odont-). Periradicular periodontitis is an alternative term.
Diagnosis
The radiographic features of periapical inflammatory lesions vary depending on the time course of the lesion. Because very early lesions
may not show any radiographic changes, diagnosis of these lesions relies solely on the clinical symptoms. More chronic lesions may show lytic (radiolucent) or sclerotic (radiopaque) changes, or both.
Classification
Classification of periapical periodontitis is usually based on whether the process is acute/symptomatic or chronic/asymptomatic.
(Note: alternative names for periapical periodontitis include 'apical periodontitis' and 'periradicular periodontitis'.)
Acute periapical periodontitis
Acute (or symptomatic) periapical periodontitis....
Malaise throbbing pain due to
Inflammation within periodontal ligament
In addition to periapical abscesses, periapical periodontitis can give rise to various related lesions, including periapical granulomas and cysts.[11] A periapical granuloma (also referred to as an 'apical granuloma' or 'radicular granuloma') is a mass of chronically inflamed granulation tissue that forms at the apex of the root of a nonvital (dead) tooth.[12] (Although not a true granuloma, given the absence of granulomatous inflammation, the term 'periapical granuloma' is widely accepted.)[12]
Treatment
Treatment options may include antibiotic therapy (in the short term, augmented by chewing gum), root canal therapy, or extraction.[citation needed]
Epidemiology
Periapical periodontitis of some form is a very common condition. The prevalence of periapical periodontitis is generally reported to vary according to age group, e.g. 33% in those aged 20–30, 40% in 30- to 40-year-olds, 48% in 40- to 50-year-olds, 57% in 50- to 60-year-olds and 62% in those over the age of 60.[13] Most epidemiologic data has been generated in European countries, especially Scandinavia. While millions of root canal treatments are carried out in the United States alone each year, total numbers of such cases do not provide reliable indicators of frequency, even for symptomatic periapical periodontitis (given that root canal treatment is not always indicated or complied with, and may also be performed in the absence of periapacial periodontitis).
References
^ abBlake, Ahren; Tuttle, Travis; McKinney, Reed (2024). "Apical Periodontitis". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID36943974. Further management is indicated when a periapical radiolucency remains unchanged after one year of root canal treatment, when it has increased in size, or if it appears in an endodontic-treated tooth without a prior apical disease.
^ abBlake, Ahren; Tuttle, Travis; McKinney, Reed (2024). "Apical Periodontitis". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID36943974. It may occur due to the advancement of dental caries, trauma, or operative dental procedures. The infected pulp is the main cause of apical periodontitis.
^Blake, Ahren; Tuttle, Travis; McKinney, Reed (2024). "Apical Periodontitis". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID36943974. A periapical radiolucency often persists when the root canal treatment cannot control the infection because some clinical steps were not adequately followed, such as insufficient aseptic control, poor instrumentation, inadequate access cavity design, unreached canals, and restoration leakage.
^Blake, Ahren; Tuttle, Travis; McKinney, Reed (2024). "Apical Periodontitis". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID36943974. Apical radiopacities are likely not associated with endodontic infection directly but are commonly found on routine radiographic evaluation. Radiopacities are generally benign.
^Blake, Ahren; Tuttle, Travis; McKinney, Reed (2024). "Apical Periodontitis". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID36943974. non-surgical endodontic retreatment or periradicular surgery are treatment alternatives to save the tooth.
^Blake, Ahren; Tuttle, Travis; McKinney, Reed (2024). "Apical Periodontitis". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID36943974. Antibiotic use is generally contraindicated, except in cases with rapid onset or systemic involvement.
^Hargreaves KM, Cohen S, Berman LH, eds. (2010). Cohen's pathways of the pulp (10th ed.). St. Louis, Mo.: Mosby Elsevier. pp. 529–555. ISBN978-0-323-06489-7.