The nature of apical periodontitis
Apical periodontitis performs an important protective function aimed at limiting the bacteria discharged from the root canal
space and prevent their spread to adjacent bone marrow spaces and other remote sites. The process is unique in the sense that it cannot eradicate the source of infection. The reason is that once a pulp become necrotic, protective mechanisms may not work far into the root canal due to the absence of cardiovascular support. Although these mechanisms can operate on the apical sidelines of necrotic tissues, they are not able to penetrate the fully developed tooth. Therefore, without proper endodontic treatment apical periodontitis
may prevail chronically.
Bone resorption is the most conspicuous feature of apical periodontitis and is an inevitable side effect of protective process. Some may consider it as a "price" paid by the host to provide appropriate, effective immune response to the root canal infection. Loss of bone mass, which appears in the x-ray is a major clinical indicator of the availability of apical periodontitis (Fig.
7.2c), as many of these lesions are silent and prevail without explicit clinical symptoms. Such defeats, will be said in this text apical periodontitis asymptomatic. Apical periodontitis asymptomatic, mainly, biofilm received (39). But, acute forms and that may develop during the expansion phase of its failure. The defeat of symptomatic apical periodontitis may also result from an imbalance between the defense and bacterial infections in an already established lesions. Symptomatic apical periodontitis results, mainly, from the actions of planktonic bacteria (11, 39). Therefore, one defeat apical periodontitis may be symptomatic or asymptomatic at different stages of their development and progression. Of course, in most cases apical periodontitis asymptomatic.
Pain, tenderness biting pressure, shock or tenderness, and swelling of the typical clinical manifestations symptomatic apical periodontitis (Fig. 7.2a, b). Symptoms can range from mild to severe. More dramatic clinical symptoms of apical periodontitis may appear to dominate, when the local immune defense failed to detain the infection by apical abscess. Although very rare, acute apical periodontitis may develop into a very serious and even life-threatening condition. Phlegmonous the spread of infection in the connective tissue around the upper respiratory tract", " Orbita", neck or even in the brain, causes anxiety. Infectious elements released in conjunction with symptomatic apical periodontits may also be distributed through the blood and cause a heart valve and myocardial infections. Although apical periodontitis may be associated with such severe clinical manifestations, it must be emphasized that its main function is to contain the root canal bacteria and prevent them dissimenation to remote objects (Core concept 7.2). Identification of apical periodontitis is directly connected with the decision of our study tools; many apical periodontitis lesions that are not visible on plain radiographs identified CBCT (cone-beam computed tomography) and many others can only be determined after histological study.
At the microscopic level, various structural framework apical periodontitis can be identified. These forms include apical granuloma, apical abscess and apical cyst. These centers will be described here in terms of their common histologic evidence, and their clinical manifestations will be discussed in more detail later in this Chapter. Clinically and radiologically these histopathological persons can not be separated from each other, or recognized, except abscesses with sinus tract.
The basic concept 7.2 the Nature of the lesion periapical
Apical periodontitis develops the following pulp tissue breakdown and the appearance of the root canal infection. This is an important protective reactions of the organism, seeking to restrict root canal bacteria and stop them from spreading to adjacent bone marrow spaces and other remote sites. One defeat apical periodontitis may or may not be present with clinical symptoms including pain, soreness, and swelling. Periapical bone resorption, although representing tissue destruction
that occurs as part of a defensive process. When bacteria, addresses the root canal treatment of active inflammatory lesions gradually subsides and regeneration of bone tissue, usually takes place. ..