Periapical periodontitis

The apical periodontitis (Latin apical, at the top ', ancient Greek παρά, next ' and ὀδούς, tooth ',- ίτις, -itis, inflammatory disease, also: apical periodontitis, apical osteitis or root tip infection) is an inflammation at the root tip a tooth and is one of the odontogenic infections. For marginal periodontitis ( gum line from starting ) see periodontitis.

Cause

Apical periodontitis is a bacterial inflammation. The bacteria enter from the pulpitis (inflammation of the dental pulp ) by the root canal or deep periodontal pockets up to the root tip. The reason is a carious defect, which serves as portal of entry for pathogens and not initially causes pain. Besides, a tooth fracture or trauma treatment, for example by grinding down the tooth for a dental crown, lead to pulpitis. An acute pulpitis can be extremely painful. In some cases, this inflammation of the pulp runs almost painless, the pulp is slowly dying off and the germs are spreading in the system of root canals and ultimately come out into the surrounding jawbone. As a defensive reaction of the immune system to washing perfused bone is broken down and replaced by better -vascularized granulation tissue. An apical periodontitis can be present in an acute or a chronic form. The acute form is often associated with pain, it can be difficult radiographically verified under certain circumstances, while a chronic apical periodontitis can be visible at a resolution of the bone structure in the region of the root tip in the X-ray image. More rarely the apical periodontitis is not bacterial, but caused by chemical stimuli a root filling or root of a drug insert.

Symptoms

Signs of apical periodontitis can be numerous. These include an adverse reaction to a sensitivity test, a dull. continuous pain with and without intra-or extraoral swelling. Furthermore, there may be an active fistula. Radiographs may determine a periapical radiolucency. In chronic apical periodontitis additional episodes of pain occur. In a symptomatic apical periodontitis clinical acute or subacute symptoms in the form of continuous pain or pain intervals are possible. For any strong bite and sensitivity to percussion may be added an apical tenderness, with redness or swelling.

In acute inflammation, the patient feels an apparent tooth extension. By the inflammatory secretions at the root tip of the tooth is lifted in the alveolus, as the Sharpey's fibers that anchor the tooth in the alveolus give the tooth some vertical freedom. This leads to typical Aufbissschmerzen. Often the tooth is sensitive already in contact with the tongue.

Progressive forms

An apical periodontal disease can be acute (primary acute apical periodontitis) or chronic ( primary chronic apical periodontitis ). The chronic form occurs with little or no pain.

If the primary chronic form turns into an acute inflammation occurs on a typical percussion pain. Radiographically apical lucencies are usually only become evident after several weeks of disease progression. As the first signs of an advanced periodontal space is visible. Changes in bone density can only be identified on the radiograph if at least 30% of the mineral content of the bone are reduced. This may take several days to weeks at a apical osteitis. At low complaints and uncertain significance of the X-ray image a repeat recording is mounted only after three months.

Indices

To facilitate the evaluation of endodontic dental films and to simplify the evaluation of the state of the Periapikalregion and standardize, where possible, various indices were developed, among other things, of the riding and Grondahl periapical Probability Index ( PRI ) or the Ørstavik Periapikalindex (PAI).

Differential Diagnosis

The distinction apical periodontitis of a odontogenic cyst ( radicular cyst ) is only by histological examination.

Therapy

The treatment consists of a root canal treatment. The localization of the causative tooth can be represented sometimes difficult because the symptoms radiate to the neighboring teeth.

Depending on the pillars value is an alternative to root canal treatment, extraction should be considered. Particularly if already greater marginal bone loss, severe tooth loosening or severe carious destruction of the crown are present.

Apical periodontitis with existing root filling

Sometimes a apical periodontitis to teeth that have been root treated a long time ago. In these cases, a revision (renewal) of the root filling or a root resection ( WSR ) is indicated. Here, the root tip of the tooth is removed, the often - run side channels of the root canal with devitalem residual tissue of the pulp - due to their small dimension can not be treated.

Wurzelspitzenresektion

After about a year, a root canal treatment of an X-ray control is subjected to test whether the apical Periodontits is completely healed. If this is not the case, even after a rule conformity root canal treatment, root resection may be necessary.

Another indication for a root resection is given when the apical inflamed tooth does not remain free of symptoms during the root canal treatment or renewed discomfort. The root resection is performed either simultaneously with the root filling or later if necessary.

Sequelae

If the apical periodontitis is not treated, then a purulent inflammation can spread into the jaw bone - apical abscess. Another possible complication is the formation of an apical granuloma, which can develop into a radicular cyst.