内容口组病交大-12-diseases of the periapical tissues

Disease

of Periapical

Tissues根尖周病Definitionperiodontal

membrane牙周膜cementum牙骨质alveolar

bone牙槽骨pulp

tissues

牙髓infectionBlood

vesselsnervelymphatic

vesselspulpitis

牙髓炎apical

foramen

根尖孔injurydeep

periodontalpocket

深牙周袋periapical

tissues

根尖周组织Classificationperiapical

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

periodontitisinflammatory

lesion

炎

变in

periodontal membrane

牙周膜of

rootapex

根尖resorption

of

cementum

and

alveolarbonePeriapical

periodontitisEtiology–

bacterial

effects

因素mostof

them

derived

from

pulpitis牙髓炎

a

defensive

reactioncariesPulpitis(Acute

or

chronic)pulpal

Necrosis牙髓坏死Periapical

inflammation

炎症Periapical

periodontitisEtiology–

bacterial

effects

因素derived

from

severe

periodontitis重度牙周炎deep

periodontal

pocket牙周袋almost

reach

to

the

root

apexperiapical

diseasesPeriapical

periodontitisEtiologyMechanical

damage

机械损伤traumaticaccidents意外损伤occlusaltrauma咬合iatrogenic

damage医源性损伤from

dental

proceduresFor

example:in

the

root

c

therapy根管治疗the

instrument

or

the

filling

materialswere

extruded

the

apical

foramenEtiologyChemical

irritation化学刺激Most

of

them

are

iatrogenicarise

from

the

procedure

of

root

ctherapy根管治疗For

example:irritative

filling

materialPeriapical

periodontitisPeriapical

periodontitisClassificationaccording

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

periodontitisacute

inflammation

around

apexsecondary

to

the

caries

and

pulpitispulpal

Necrosisbacteriaposed

products

of

pulp

and

the

toxininflammation

of

periapical

tissueassociation

with

a

nonvital

tooth

死髓牙Acute

periapical

periodontitissecondary

to

trauma外伤high

occlusal

contacts咬合wedging

by

a

foreign

object异物嵌塞a

vital

tooth活髓牙an

acute

exacerbation

急性发作ofchronic

periapical

periodontitisAcute

periapical

periodontitisClassificationacute

serous

periapical

periodontitis急性浆液性根尖周炎acute

purulent(suppurative)

periapicalperiodontitis急性化脓性根尖周炎acute

periapical

abscess

or

acute

alveolarabscess急性根尖脓肿或急性牙槽脓肿Acute

periapical

periodontitisClinical

features临床表现symptomatic

as

the

inflamed

exudates炎性渗出物accumulates

within

the

periapical

tissuesinitial

stagetenderness

of

the

affected

tooth患牙疼痛relieved

by

direct

application

of

pressure咬合压力下缓解sera

squeezedout

of

the

dilation扩张blood

vesselsAcute

periapical

periodontitisClinical

featuresProgressionpain

more

intenseextreme

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

butis

circumscribed局限indicate

the

affected

toothacute

serous

inflammatory

stageAcute

periapical

periodontitisClinical

featuresacute

serous

inflammatory

stageacute

serous

periapical

periodontitisshortpurulent

stageacute

purulent

periapical

periodontitisAcute

periapical

periodontitisClinical

featuresThe

neutrophils

degenerate

and

die

and

formthepus中性白细胞pus

accumulate

and

form

the

abscess

脓肿(acute

purulent

periapical

periodontitisor

acute

alveolar

abscess

)the

pain

violent剧烈and

persistent持续extreme

sensitivity

to

percussion叩诊extrusion

of

the

tooth

evidentlyswelling

of

the

tissues脓液Acute

periapical

periodontitisClinical

featuresheadache,

malaise,

fever

and

chills

may

bepresentspread

along

thepath

ofleastthrough

the

medullary

spaces骨髓腔osteomyelitis骨髓炎perforate

the

cortex骨皮质cellulites蜂窝织炎Acute

periapical

periodontitisClinical

featuresabscess

in

the

softtissuecelluliteschannelize

through

theoverlying

soft

tissuechannelize

through

theskinintraoral

sinus口内窦道cutaneous

sinus皮肤窦道drain

the

purulent

materialAcute

periapical

periodontitisRadiographic

features

X线表现a

thickening

of

the

apicalperiodontal

ligament牙周韧带no

appreciable

alternationsAcute

periapical

periodontitisHistopathologic

features

组织学表现a

central

area

of

disintegrating

neutrophilssurrounded

byleukocytes白细胞andlymphocytesdilatation

of

the

blood

vessels

in

the

adjacenttissuesmarrow

spaces

shows

an

inflammatory

cellinfiltratearound

the

area

of

suppuration

contains

aserous

exudates

浆液渗出Chronic periapical

periodontitisnosymptommildpain

or

unfit

when

biting

or

chewing

onsolid

foodacute

exacerbation急性发作when

theof

immunity

system

decreasingimportant

histopathologic

featurethe

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

periodontitisClassificationchronic

periapical

abscess慢性根尖脓肿periapical

granuloma根尖肉芽肿Chronic

periapical

abscesschronic

suppurative

periapicalperiodontitis慢性化脓性根尖周炎chronic

alveolar

abscess慢性牙槽脓肿chronic

suppurative

inflammation

of

periapicaltissuesresults

from

acute

periapical

abscess

or

periapicalgranulomaChronic

periapical

abscessClinical

featuresasymptomaticsensitivity

to

percussionmild

pain

occasioned

when

biting

or

chewingonsolid

foodformation

of

fistulous瘘管形成if

the

lesionundergoes

an

acute

exacerbationtwotypesnonvital

toothChronic

periapical

abscessRadiographic

featuresa

radiolucent

area透光区of

variable

sizeattached

to

the

root

apexthe

radiolucency

is

ill-defined界限不清andirregular-shaped形状不规则the

adjacent

bone

lack

of

a

thin

radiopaqueline

or

zone骨质反应线the

diameter

of

the

lesion

is

often

less

than

2centimeterChronic

periapical

abscessHistopathologic

features–

the

centerthe

pus

contains

the

necrotic

anddegenerative

neutrophilsintermixed

with

inflammatory

exudates,cellular

debris

and

histocytes组织细胞–

around

the

pusthe

fiber

connective

tissuewallinfiltrated

with

neutrophils,macrophages巨噬细胞,lymphocytes

、plasma

cells浆细胞Chronic

periapical

abscessHistopathologic

featuresin

the

near

periapical

tissuedilation

of

theblood

vesselsthe

serous

effusion浆液渗出if

fistula

formationthe

wall

of

fistulathe

inflamed

granulation

tissueseveral

of

them

are

with

theepitheliumlining上皮衬里Periapical

granulomathe

most

common

of

all

sequelae

ofpulpitischronic

inflamed

granulation

tissue慢性炎性肉芽组织Periapical

granulomaClinical

featuresasymptomaticpain

and

sensitivity

if

acute

exacerbation

occurstypically

the

involved

tooth

does

not

demonstratemobilitysignifican sitivity

to

percussionnonvital

toothdoes

not

respond

to

thermal

or

electric

pulp

tests牙髓电检测no

formation

ofa

fistulous

tractFistula

formation

if

undergoes

an

acute

exacerbationPeriapical

granulomaRadiographic

features:radiolucent

area

attached

to

the

root

apextheradiolucency

iswell-circumscribeddemarcated

from

the

surrounding

bonelack

of

a

thin

radiopaque

line

or

zonePeriapical

granulomaHistopathologic

featuresinflamed

granulation

tissue

surrounded

by

afibrous

connective

tissue

wallLymphocytic淋巴细胞

infiltrate

intermixedwith

neutrophils中性白细胞,plasma

cells浆细胞,histocytes组织细胞,mastcells肥大细胞and

eosinophils嗜酸性细胞Periapical

granulomaHistopathologic

featuressheers

of

foam

cells

细胞Phagocytes巨噬细胞ingest

lipid

material

ande

collected

ingroupscholesterol

crystals胆固醇结晶clear

needle-like

spaces

or

cleftsmicroscopicallydissolving

of

cholesterol

by nts

usedin

thepreparationPeriapical

granulomaHistopathologic

featuresanother

important

feature

-----thepresenceof

epitheliumoriginthe

epithelial

rests

of

Malassezrespiratory

epithelium

of

the

maxillary

sinusoral

epithelium

growing

in

through

a

fistulous

tractoral

epithelium

proliferating

apically

from

aperiodontal

pocketepithelium

stimulated

by

the

inflammationextensive,

sheets

of

stratified

aquamous

epithelium

cell复层鳞状上皮anastomosing吻合cordsPeriapical

cystradicular

cystroot

end

cysta

true

cysta

pathologic that

is

lined

byepithelium

and

fluid-filledPeriapical

cystThe

origin

of

the

epithelial

liningthe

epithelial

rests

of

Malassezrespiratory

epithelium

of

the

maxillary

sinus上颌窦oral

epithelium

growing

in

through

afistulous

tractoral

epithelium

proliferating

apically

from

aperiodontal

pocketPeriapical

cystClinical

featuresnosymptomsswelling

and

mild

sensitivitymovementand

mobility

of

adjacent

teethnonvital

toothnot

respond

to

thermal

and

electric

pulptesting.Periapical

cystRadiographic

featureidentical

to

that

of

a

periapical

granulomaa

radiolucent

area

attached

to

the

root

apexgreater

size

than

the

granulomathe

size

is

often

between

1-2

centmetreradiolucency

is

well-circumscribed

lesionand

have

a

thin

radiopaque

lineroot

resorption

is

commonPeriapical

cystHistopathologic

featureslined

by

stratified

squamous

epitheliumspongiosis海绵状水肿or

hyperplasis增生seldom

exhibits

keratin

formationthe

thickness

varies

remarkably

from

case

to

case.lined

with

a

pseudo-stratified

ciliatedcolumnar

假复层纤毛柱状上皮or

respiratorytype

of

epithelium呼吸道上皮if involved

themaxillary

sinus上颌窦Periapical

cystHistopathologic

featuresthe

wal