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nullDisease of Periapical TissuesDisease of Periapical Tissues根 尖 周 病DefinitionDefinitionperiodontal membrane牙周膜 cementum牙骨质 alveolar bone牙槽骨 nullpulp tissues 牙髓 apical foramen 根尖孔 periapical tissues 根尖 周组织 Blood vessels nerve lymphatic vessels pulpitis 牙髓炎 infection injury deep periodontal pocket 深牙周袋ClassificationClassificationperiapical periodontitis根尖周炎 acute急性 chronic慢性 chronic periapical abscess慢性根尖脓肿 periapical granuloma根尖肉芽肿 periapical cyst根尖囊肿Periapical periodontitis Periapical periodontitis inflammatory lesion 炎性病变 in periodontal membrane 牙周膜 of root apex 根尖 resorption of cementum and alveolar bone Periapical periodontitisPeriapical periodontitisEtiology bacterial effects 感染因素 most of them derived from pulpitis牙髓炎 a defensive reaction caries   Pulpitis (Acute or chronic) pulpal Necrosis牙髓坏死 Periapical inflammation 炎症 Periapical periodontitisPeriapical periodontitisEtiology bacterial effects 感染因素 derived from severe periodontitis重度牙周炎 deep periodontal pocket牙周袋 almost reach to the root apex   periapical diseases Periapical periodontitisPeriapical periodontitisEtiology Mechanical damage 机械损伤 traumatic accidents意外损伤 occlusal trauma咬合创伤 iatrogenic damage医源性损伤 from dental procedures For example: in the root canal therapy根管治疗 the instrument or the filling materials were extruded the apical foramen Periapical periodontitisPeriapical periodontitisEtiology Chemical irritation化学刺激 Most of them are iatrogenic arise from the procedure of root canal therapy 根管治疗 For example: irritative filling material Periapical periodontitisPeriapical periodontitisClassification according to the duration of disease 病程 acute periapical periodontitis急性根尖周炎 chronic periapical periodontitis 慢性根尖周炎Acute periapical periodontitis Acute periapical periodontitis acute inflammation around apex secondary to the caries and pulpitis pulpal Necrosis decomposed products of pulp and the toxin inflammation of periapical tissue association with a nonvital tooth 死髓牙 bacteriaAcute periapical periodontitisAcute periapical periodontitissecondary to trauma外伤 high occlusal contacts咬合创伤 wedging by a foreign object异物嵌塞 a vital tooth活髓牙 an acute exacerbation 急性发作of chronic periapical periodontitis Acute periapical periodontitisAcute periapical periodontitisClassification acute serous periapical periodontitis 急性浆液性根尖周炎 acute purulent(suppurative) periapical periodontitis 急性化脓性根尖周炎 acute periapical abscess or acute alveolar abscess 急性根尖脓肿或急性牙槽脓肿Acute periapical periodontitisAcute periapical periodontitisClinical features临床 表 关于同志近三年现实表现材料材料类招标技术评分表图表与交易pdf视力表打印pdf用图表说话 pdf 现 symptomatic as the inflamed exudates炎性渗出物 accumulates within the periapical tissues initial stage tenderness of the affected tooth患牙疼痛 relieved by direct application of pressure咬合压力下缓解 sera squeezed out of the dilation扩张 blood vessels Acute periapical periodontitisAcute periapical periodontitisClinical features Progression pain more intense extreme sensitivity to chewing咀嚼 the affected tooth extrude from its socket患牙伸长 the pain is spontaneous自发, persistent持续 but is circumscribed局限 indicate the affected tooth acute serous inflammatory stage Acute periapical periodontitisAcute periapical periodontitisClinical features acute serous inflammatory stage acute serous periapical periodontitis purulent stage acute purulent periapical periodontitis shortAcute periapical periodontitisAcute periapical periodontitisClinical features The neutrophils degenerate and die and form the pus pus accumulate and form the abscess 脓肿 (acute purulent periapical periodontitis or acute alveolar abscess ) the pain violent剧烈 and persistent持续 extreme sensitivity to percussion叩诊 extrusion of the tooth evidently swelling of the tissues 中性白细胞脓液nullAcute periapical periodontitisAcute periapical periodontitisClinical features headache, malaise, fever and chills may be present spread along the path of least resistance through the medullary spaces osteomyelitis 骨髓腔 骨髓炎 perforate the cortex cellulites 骨皮质 蜂窝织炎Acute periapical periodontitisAcute periapical periodontitisClinical features abscess in the soft tissue cellulites channelize through the overlying soft tissue channelize through the skin intraoral sinus口内窦道 cutaneous sinus皮肤窦道 drain the purulent material nullnullAcute periapical periodontitisAcute periapical periodontitisRadiographic features X线表现 a thickening of the apical periodontal ligament牙周韧带 no appreciable alternationsnullAcute periapical periodontitisAcute periapical periodontitisHistopathologic features 组织学表现 a central area of disintegrating neutrophils surrounded by leukocytes白细胞 and lymphocytes dilatation of the blood vessels in the adjacent tissues marrow spaces shows an inflammatory cell infiltrate around the area of suppuration contains a serous exudates 浆液渗出 nullChronic periapical periodontitisChronic periapical periodontitisno symptom mild pain or unfit when biting or chewing on solid food acute exacerbation急性发作when the resistance of immunity system decreasing important histopathologic feature the formation of the inflamed granulation tissue 炎性肉芽组织 the absorption of the alveolar bone牙槽骨吸收 Chronic periapical periodontitisChronic periapical periodontitisClassification chronic periapical abscess 慢性根尖脓肿 periapical granuloma 根尖肉芽肿 Chronic periapical abscess Chronic periapical abscess chronic suppurative periapical periodontitis 慢性化脓性根尖周炎 chronic alveolar abscess 慢性牙槽脓肿 chronic suppurative inflammation of periapical tissues results from acute periapical abscess or periapical granuloma Chronic periapical abscessChronic periapical abscessClinical features asymptomatic sensitivity to percussion mild pain occasioned when biting or chewing on solid food formation of fistulous瘘管形成 if the lesion undergoes an acute exacerbation two types nonvital tooth Chronic periapical abscessChronic periapical abscessRadiographic features a radiolucent area透光区 of variable size attached to the root apex the radiolucency is ill-defined界限不清 and irregular-shaped形状不规则 the adjacent bone lack of a thin radiopaque line or zone骨质反应线 the diameter of the lesion is often less than 2 centimeter Chronic periapical abscessChronic periapical abscessHistopathologic features the center the pus contains the necrotic and degenerative neutrophils intermixed with inflammatory exudates, cellular debris and histocytes组织细胞 around the pus the fiber connective tissue wall infiltrated with neutrophils, macrophages巨噬细胞, lymphocytes 、plasma cells浆细胞 Chronic periapical abscessChronic periapical abscessHistopathologic features in the near periapical tissue dilation of the blood vessels the serous effusion浆液渗出 if fistula formation the wall of fistula the inflamed granulation tissue several of them are with the epithelium lining上皮衬里nullnullPeriapical granuloma Periapical granuloma the most common of all sequelae of pulpitis chronic inflamed granulation tissue 慢性炎性肉芽组织Periapical granulomaPeriapical granulomaClinical features asymptomatic pain and sensitivity if acute exacerbation occurs typically the involved tooth does not demonstrate mobility significant sensitivity to percussion nonvital tooth does not respond to thermal or electric pulp tests牙髓电 活力检测 no formation of a fistulous tract Fistula formation if undergoes an acute exacerbationPeriapical granulomaPeriapical granulomaRadiographic features: radiolucent area attached to the root apex the radiolucency is well-circumscribed demarcated from the surrounding bone lack of a thin radiopaque line or zone nullPeriapical granulomaPeriapical granulomaHistopathologic features inflamed granulation tissue surrounded by a fibrous connective tissue wall Lymphocytic淋巴细胞 infiltrate intermixed with neutrophils中性白细胞, plasma cells浆细胞, histocytes组织细胞, mast cells肥大细胞 and eosinophils嗜酸性细胞 Periapical granulomaPeriapical granulomaHistopathologic features sheers of foam cells泡沫细胞 Phagocytes巨噬细胞 ingest lipid material and become collected in groups cholesterol crystals胆固醇结晶 clear needle-like spaces or clefts microscopically dissolving of cholesterol by the agents used in the preparationPeriapical granulomaPeriapical granulomaHistopathologic features another important feature -----the presence of epithelium origin the epithelial rests of Malassez respiratory epithelium of the maxillary sinus oral epithelium growing in through a fistulous tract oral epithelium proliferating apically from a periodontal pocket epithelium stimulated by the inflammation extensive, sheets of stratified aquamous epithelium cell 复层鳞状上皮 anastomosing吻合cords nullnullnullnullPeriapical cystPeriapical cystradicular cyst root end cyst a true cyst a pathologic cavity that is lined by epithelium and fluid-filled Periapical cystPeriapical cystThe origin of the epithelial lining the epithelial rests of Malassez respiratory epithelium of the maxillary sinus上颌窦 oral epithelium growing in through a fistulous tract oral epithelium proliferating apically from a periodontal pocket Periapical cystPeriapical cystClinical features no symptoms swelling and mild sensitivity movement and mobility of adjacent teeth nonvital tooth not respond to thermal and electric pulp testing. Periapical cystPeriapical cystRadiographic feature identical to that of a periapical granuloma a radiolucent area attached to the root apex greater size than the granuloma the size is often between 1-2 centmetre radiolucency is well-circumscribed lesion and have a thin radiopaque line root resorption is common nullPeriapical cystPeriapical cystHistopathologic features lined by stratified squamous epithelium spongiosis海绵状水肿 or hyperplasis增生 seldom exhibits keratin formation the thickness varies remarkably from case to case. lined with a pseudo-stratified ciliated columnar 假复层纤毛柱状上皮or respiratory type of epithelium呼吸道上皮 if involved the maxillary sinus上颌窦 Periapical cystPeriapical cystHistopathologic features the wall of the cyst dense fibrous connective tissue often with an inflammatory infiltration containing lymphocytes, neutrophils, plasma cells, histocytes, and mast cells and eosinophils The lumen filled with fluid and cellular debris nullPeriapical cystPeriapical cystHistopathologic features distrophic calcification cholesterol clefts胆固醇结晶裂隙 multinucleated foreign body type giant cells Lumen 异物多核巨细胞 wall Both Most of them near the cholesterol clefts nullPeriapical cystPeriapical cystHistopathologic features hyaline body透明小体 or Rushton body described by Rushton tiny linear or arc-shaped bodies线性或弓形小体 small circumscribed pools of eosinophilic material generally associated with the lining epithelium amorphous(无定形) in structure, eosinophilic in reaction, and brittle in nature Periapical cystPeriapical cystHistopathologic features hyaline body透明小体 or Rushton body The etiology, pathogenesis, and significance of these structure are unknown hematogenous origin odontogenic origin represente a type of keratin or enamel cuticle nullnull