Milestone In Periapical Interpretation And Reporting Short Notes Question And Answers

1. Periapical Abscess:

• Teeth seen: 45,46,47 and partial image of 48. Anatomical landmarks: Nil.
• Anatomical structures: Crown, root, pulp chamber, pulp canal and periapical region, crestal bone, and trabecular pattern are normal in 45 and 47.

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Periapical Abscess Pathological Interpretation:

• Radiolucency is evident on the coronal structure of 46 with loss of mesiolingual and mesiobuccal cusp architecture involving enamel, dentin, and pulp.
• The periphery of the radiolucency is diffused extending towards the pulp chamber of 46.
• The pulp canal is partially obliterated in the mesial and distal root of 46.
• Loss of lamina dura is evident on the mesial and distal root of 46.
• PDL space is widened with distinct radio-lucency in 46.
• A triangular radiolucency evident on the bifurcation area of 46 is suggestive of furcation involvement.

Periapical Abscess Radiodiagnosis: Dental caries in 46 with periapical abscess.

2. Secondary Caries

• Teeth seen: 31, 32, 41, 42, and partial image of 33 and 43.
• Anatomical landmarks: Nutrient canal, genial tubercle, lingual foramen.

Secondary Caries Pathological Interpretation:

• Radiolucency is evident on the mesial aspect of the coronal structure of 31 with a thin group 2 radiopaque restorative boundary suggesting dislodged restorative material.
• Diffused radiolucency is evident immediately next to the radiopaque restorative material involving pulp of 31.
• Lamina dura is intact with normal PDL space, and no periapical changes are evident in 31.
• Group 2 restorative material is evident on the mesial and distal surface of the coronal structure with restorative boundaries close to a pulp in 41.
• The pulp canal is normal with intact lamina dura and PDL space, and no periapical changes are evident in 41.
• Radiolucency is evident on the mesial surface of the coronal portion of 32 and 42 involving enamel.

Secondary Caries Radiodiagnosis:

• Secondary caries with pulpal involvement in 31.
• Restored crown in 41 without pulpal involvement.
• Enamel caries in 32 and 42.

3. Post and Core:

• Teeth seen: 25, 26
• Anatomical structures: Edentulous region mesial to 25 and distal to 26 with normal alveolar bone pattern.
• Anatomical landmarks: Zygoma

Post and Core Pathological Interpretation:

• Prefabricated metal post fitted and cemented into the pulp chamber and pulp canal of 25 which is continued with group 2 radiodense restorative material, probably gutta pecha on the apical third of 25, extending a bit beyond the apical foramen indicating complete obturation.
• Group 2 radiodense restorative material is evident on the entire coronal structure indicating poor restoration.
• No periapical bone resorption is evident in 25.
• Diffused radiolucency is evident in the mesioproximal aspect of 26 involving both the buccal-and palatal cusp. The radiolucency expands from enamel towards dentin and mesial pulp horn. Lamina dura is intact with normal PDL space, and no periapical bone resorption is evident.

Post and Core Radiodiagnosis:

• Post and core restoration in 25.
• Proximal caries 26 with pulpal involvement.

4. Chronic Periodontitis:

• Teeth seen: 13,14,15
• Anatomical structure: Crest of alveolar ridge distal to 15 in a line parallel to the apical third of root structure.
• Anatomical landmarks: Zygoma, floor of the maxillary sinus, maxillary sinus with a septum.

Chronic Periodontitis Pathological Interpretation:

• The radiolucent area is evident on the occlusal surface of 14, 15 bounded by occlusal and proximal radiolucency of enamel.
• Radiolucency is evident in the inter-radicular region between 13-14 and 14-15 indicating receiving crestal bone height. The bone recession extends from CEJ to the apical third of the root in the distal aspect of 13 and the mesial and distal aspect of 14 and 15.
• Loss of lamina dura evident in 14, 15 with irregular widening of PDL space along the entire root.
• Cortical bone resorption in uneven sugges¬ting inconsistent bony margins in the 13, 14, and 15 region.

Chronic Periodontitis Radiodiagnosis:

• Mach band effect 14,15
• Chronic periodontitis (Stage 2: Established periodontitis).

5. Dental Caries with Apical Periodontitis

Teeth seen: 44, 45, 46, and partial image of 47

Anatomical landmarks: NIL

Anatomical structures: Crown, root, pulp chamber, pulp canal and periapical region, crestal bone, and trabecular pattern are normal in 45 and 44.

Dental Caries with Apical Periodontitis Pathological Interpretation:

• A well-defined radiolucency is evident on the occlusal and distobuccal of 46 which is sharply demarcated from the surrounding tooth structure with a loss of distobuccal cuspal morphology evident.
• The radiolucency extends to involve the pulp chamber. Lamina dura is intact on the mesial root with discontinuity evident on the apical region of the distal root of 46. PDL space is thickened in the apical region of the mesial root of 46.
• The furcal area is normal with no evidence of resorption.

Dental Caries with Apical Periodontitis Radiodiagnosis: DC in 46 with apical periodontitis.

6. Root Stump

• Teeth saw: 44, 45,47, and partial image of 48.
• Anatomical landmarks: NIL
• Anatomical structures: Crown, root, pulp chamber, pulp canal and periapical region, crestal bone, and trabecular pattern are normal in 44, 45, and 47.

Root Stump Pathological Interpretation:

• Radiolucency is evident in between 45 and 47 along the alveolar region suggesting a loss of coronal structure of 46, two distal root structures evident with the partial obliteration of the pulp canal, and complete loss of lamina dura evident at the alveolar bone level suggesting the mesial and distal root structure of 46.
• The cervical end of root structures shows an irregular outline with hazy radiolucency indicating a sign of resorption.

Root Stump Radiodiagnosis: Root Stump 46.

7. Impaction:

• Teeth seen: 37, 38, partial image of 36.
• Anatomical landmarks: Inferior alveolar
• Anatomical structures: Crown, root, pulp chamber, pulp canal and periapical region, crestal bone, and trabecular pattern are normal in 45 and 47.

Impaction Pathological Interpretation:

• The distal aspect of the crown of 38 is engorging on the ramus and is covered by the alveolar crest.
• The distal aspect of the coronal portion of 48 is impinging on the ascending ramus.
• No pulpal changes are evident.
• Distal root abiogenesis is incomplete.

Impaction Radiodiagnosis: Pell and Geogrey Class 2, Distoangular Impaction.

8. Canine Impaction:

• Teeth seen: 63, 24, partial image of 22.
• Anatomical landmarks: Nil
• Anatomical structures: Crown, root, pulp chamber, pulp canal and periapical region, crestal bone, and trabecular pattern are normal in 45 and 47.

Canine Impaction Pathological Interpretation:

• A radiopaque orthodontic band is evident at the cuspal surface of 24.
• Tiny tooth structure revealing enamel, dentin, and pulp chamber suggesting crown of 63, loss of root structure evident in 63 with blunted cervical 3rd.
• A tooth structure with the complete formation of crown and root morphology is evident at the alveolar bone level, positioned horizontally in relation to roots of 24 and 22.
• No bony changes were evident in the region.

Canine Impaction Radiodiagnosis:

• Retained 63 with resorbed roots.
• Impacted 23.

9. Odontome:

• Teeth seen: 21, 22, partial image of 24, 25.
• Anatomical landmarks: Nil
• Anatomical structures: Crown, root, pulp chamber, pulp canal and periapical region, crestal bone, and trabecular pattern are normal in 21 and 22.

Odontome Pathological Interpretation:

• Multiple tiny radiopaque structures are evident on the alveolar crest.
• A tooth structure resembling the morphology of the crown is evident at the alveolar bone level along the roots of 21, 22 and the incisal 3rd of the root apex of 22 suggesting impacted 23 positioned semi vertically.
• A tiny radiopaque structure resembling the enamel, dentin, and pulp of a crown structure is evident overlapping the proximal surface of the cervical 3rd of the root of the impacted 23.
• Well-defined radiolucency surrounded by a radiopaque certification is seen encircling impacted 23 and the adjacent crown-like structure of multiple tiny radiopaque structures suggesting follicular space.

Odontome Radiodiagnosis: Odontome with impacted 23 with supernumerary teeth.

10. Established Chronic Periodontitis:

• Teeth seen: 46, 47, and partial image of 45.
• Anatomical landmarks: NIL
• Anatomical structures: Crown, root, pulp chamber, and pulp canal are normal in 45.

Established Chronic Periodontitis Pathological Interpretation:

• Extensive crestal bone loss is evident between 46 and 47 in obtuse angle suggesting vertical bone defect with a distal aspect of 47 extending into root apex.
• Triangular radiolucency is evident in the bifurcation area of 47.
• Resorption changes are also evident in the bifurcation area of 46.
• No pulpal changes are evident.
• Thickening of PDL space is evident at the mesial and distal roots of 46, 47.

Established Chronic Periodontitis Radiodiagnosis:

• Chronic periodontitis: 46,47 (established stage or Stage 4).

11. Internal Resorption

• Teeth seen: 11, 12, and partial image of 22.
• Anatomical landmarks: Floor of nasal fossa, intermaxillary suture, nasal septum, the shadow of the upper lip.
• Anatomical structures: Crown, root, pulp chamber, pulp canal, and trabecular pattern are normal in 22.

Internal Resorption Pathological Interpretation:

• Radiolucency is evident at the incisal edge of 11, 21 with evidence of loss of normal enamel structure in the incisal and middle 3rd region of 11, 21.
• Diffuse semicircular radiolucency evident in the cervical 3rd root of 11 involving pulp canal.
• Diffuse scooped out radiolucency evident on the distoproximal aspect of the cervical root portion of 21.
• Radiolucency expanding towards pulp. Incomplete obliteration of pulp canal evident in cervical and apical 3rd root of 21.
• Discontinuity of lamina dura and widening of PDL space in 21.
• Crestal bone loss is evident between 21 and 22 extending upto the middle 3rd of roots of 21 and 22.

Internal Resorption Radiodiagnosis:

• Internal resorption in 11.
• Root caries in 21 with apical periodontitis.

12. Incomplete Obturation with Periapical Abcess:

• Teeth seen: 45,46, 47, and partial image of 48.
• Anatomical landmarks: NIL

Periapical Abscess Pathological Interpretation:

• Radiolucency is evident on the occlusal surface of 46. Group I radiopaque restorative material is evident on the pulp chamber of 46 and Group II restorative material is evident in the mesial-and distal canal of 46.
• Lateral adaptation of restorative material is incomplete in the distal root of 46.
• Well-defined radiolucency is evident in the periapical region of the distal root of 46 suggesting bone resorption.
• Well-defined radiolucency is evident on the crown structure of 47 involving enamel, dentin, and pulp. The radiolucency is well demarcated from surrounding enamel and dentin.
• Irregular thickening of PDL space is evident in the apical region and furcal area of 47.

Periapical Abcess Radiodiagnosis:

• Incompletely obturated distal canal in 46 with periapical abscess.
• Facial/lingual caries in 47 with apical periodontitis.

13. Idiopathic Osteosclerosis:

• Teeth seen: 36, 37, and partial image of 35, 34.
• Anatomical landmarks: NIL
• Anatomical structures: Crown, root, pulp chamber, pulp canal, and periapical region, trabecular pattern are normal in 36 and 35.

Idiopathic Osteosclerosis Pathological Interpretation:

• Crestal bone loss is evident between the roots of 35-36, and 36-37, and bone reduction is perpendicular to CEJ of 35, 36, and 37. No pulpal or periapical changes are evident in 35-37 region.
• Lamina dura is intact with a normal appearance of PDL space.
• A well-defined high, dense, homogenous radiopaque structure is evident at the alveolar bone level adjacent and apical to roots of 36 and 37.

Idiopathic Osteosclerosis Radiodiagnosis: Idiopathic osteosclerosis.

14. Odontome

• Teeth seen: 71, 32, 41, 42, and partial image of 33, 43.
• Anatomical landmarks: Inferior border of the mandible and mental ridge.
• Anatomical structures: Crown, root, pulp chamber, pulp canal, periapical region, and trabecular pattern are normal in 32, 41, 42, 33, and 43.

Odontome Pathological Interpretation:

• Loss of apical root structure is evident in 31.
• A tooth structure resembling the morphology of an incisor at the alveolar bone level between the root apices of 32 and 41 with normal enamel, dentin, and pulp cavity.
• Multiple discrete radiopaque structures are evident at the alveolar crest level between 32 and 41, overlapping the root of 41 and the crown of impacted 31.
• The radiopaque mass is surrounded by a radiolucent rim.

Odontome Radiodiagnosis:

• Impacted—31
• Retained—71
• Odontome

15. Dental Caries with Apical Periodontitis:

• Teeth seen: 32, 31, 41, 42 and partial image of 33, 43.
• Anatomical landmarks: NIL

Apical Periodontitis Pathological Interpretation:

• Diffuse radiolucency is evident on the coronal aspect of 41, involving enamel, dentin, and pulp.
• Discontinuity of lamina dura is evident in the apical region of 41.
• Mild cortical bone resorption is evident in the periapical region of 41.
• Radiolucency is evident on the mesial-and distal proximal surface of the crown of 31. On the mesial aspect, radiolucency is extending toward the pulp. On the distal aspect, it is involving enamel and dentin.
• Discontinuity of lamina dura evident with uniform widening of PDL space along the root of 31.
• Well-defined radiolucency is evident on the coronal structure of 32, which is sharply demarcated from the surrounding dentin and expanding to involve pulp.
• Discontinuity of the lamina dura evident at the root apex of PDL space is evident along the distal surface of the root. Well-defined radiolucency at the apical region of 32.

Apical Periodontitis Radiodiagnosis:

• Dental caries in 41 with apical periodontitis (PAI-4).
• Dental caries in 31 with apical periodontitis (PAI-3).
• Facial/Lingual caries in 32 with periapical abscess (PAI-5).

16. Restored Tooth with Periapical Abscess

• Teeth seen: 34, 35, 36, 37.
• Anatomical landmarks: NIL
• Anatomical structures: Crown, root, pulp chamber, pulp canal and periapical region, crestal bone, and trabecular pattern are normal in 34, 35, and 37.

Periapical Abscess Pathological Interpretation:

• Group I restorative material evident on the coronal aspect of 36 involving enamel, dentin, and pulp.
• Diffuse radiolucency is evident encircling the mesial-and distal roots of 36 indicating bone resorption, discontinuity of lamina dura, and thickening of PDL space evident.
• Radiolucency is evident at the furcal region of 36.

Periapical Abscess Radiodiagnosis: Restored 36 with periapical abscess. (PAI-5).

17. Extrusion

• Teeth seen: 21, 22, 11, and partial image of 12,23.
• Anatomical landmarks: Intermaxillary sutures, floor of nasal fossa, nasal septum, nasal spine.
• Anatomical structures: Partial axial displacement of tooth out of the socket.

Extrusion Pathological Interpretation:

• Uniform widening of the pulp canal is evident as radiolucency with a smooth well-defined margin with distorted morphology of the pulp canal.
• Bone rarefaction is evident at the periapical region of 11.
• The apex of 21 is below the level of apices of 11 and 22.
• The root of 21 is partially displaced out of its socket as indicated by generalized thicke¬ning of PDL space and radiolucency at the lateral aspect of 21.

Extrusion Radiodiagnosis: Extruded 21.

18. Coronal Fracture with Periapical Cyst:

• Teeth seen: 11, 21, 22, partial image of 12.
• Anatomical landmarks: Intermaxillary suture, nasal septum, floor of nasal fossa.

Periapical Cyst Pathological Interpretation:

• Partial loss is of coronal tooth structure evident as a radiolucent structure on the mesial side of the coronal portion of 22 invol¬ving pulp.
• A thin radiolucent line running vertically on the midline, continuation with the remaining crown structure suggestive of vertical fracture of the crown.
• A well-defined radiolucency encircling the apex of 22 with a well-defined cortical boundary. The size of radiolucency is approximately 1 x 1 cm in size.
• Discontinuity of lamina dura with thicke¬ning of PDL space is evident.
• A step formation is evident as radiolucency with clear radiopaque boundary evident on the mesioproximal angle of 21, and discontinuity of the incisal third of coronal structure is evident as sharp radiolucent line in 11 and 21.
• Uniform widening of the pulp canal is evident in the coronal third of roots of 11 and 21.
• Discontinuity of the lamina dura with the widening of PDL space is evident with diffuse radiolucency measuring less than 1 cm approximately, evident at the periapical region of 21 indicating bone resorption.
• Widening of PDL space with loss of lamina dura evident in 11 with diffused radio- lucency measuring 1 x 1 cm in diameter approximately at the periapical region of 11.
• Loss of typical constriction of the apical third of root structures evident in 11 and 21 appear as flattened surfaces.

Periapical Cyst Radiodiagnosis:

• Coronal fracture 22 with periapical cyst. (PAI-5)
• Coronal fracture 11, 21 with periapical abscess and external root resorption.

19. Advanced Periodontitis (Stage 4):

• Teeth seen: 32, 31, 41, 42 and partial image of 33, 43.
• Anatomical landmarks: Lingual foramen, Genial tubercle, nutrient canal

Advanced Periodontitis Pathological Interpretation:

• Reduction of crestal bone height is evident between 32-31, 31-41, the bone recession extends from CEJ to the apical third of 31, 32, 41 and perpendicular to the direction to CEJ.
• Thickening of PDL space evident along the root with loss of lamina dura.
• Nonhomogeneous radiopaque spikes are evident at the middle third of the root structure suggesting of subgingival calculus.

Advanced Periodontitis Radiodiagnosis: Advanced periodontitis (stage 4).

20. Incomplete Root Canal Obturation with Periapical Abscess:

• Anatomical landmarks: Zygoma, maxillary sinus.
• Anatomical structures: Crown, root, pulp chamber, pulp canal and periapical region, crestal bone, and trabecular pattern are normal in 26 and 25.

Periapical Abscess Pathological Interpretation:

• Partial loss of coronal structure of 24 evident with loss of distal cusp morphology.
• Group 1 radiopaque restorative material evident on the coronal structure involving enamel, dentin, and pulp chamber.
• Group 2 radiopaque restorative material is evident on the pulp canal of the buccal root and incomplete obturation of the pulp canal is evident on the palatal root with obturation material evident only the apical 3rd of the palatal root.

Periapical Abscess Radiodiagnosis:

• Well-defined radiolucency is evident in the apical region of the buccal and palatal root suggesting bone resorption.
• Incomplete root canal obturation of 24 with periapical abscess (PAI-4).