Radicular Cyst

Radicular Cysts . Cysts are fluid-filled cavity pathological semi-liquid or gaseous materials are usually walled connective tissue and contains fluid or semi-viscous liquid, it can be in soft or hard tissue like bone. Cyst cavity in the oral cavity is always limited by the epithelial layer and the outside covered with connective tissue and blood vessels.
Radicular cyst is also called periapical cyst. These cysts are the most common type of cyst was found. Radicular cyst is formed by the chronic irritation that is not vital teeth. These cysts grow from the epithelial rest of Malassez proliferation experiencing due to the inflammatory response triggered by bacterial infection due to pulp necrosis
Periapical cyst is a cyst that forms on the tip apex (root) of the teeth which had nonvital tissue pulpanya / off. Cyst is a continuation of pulpitis (inflammation of the pulp). Can occur in any tooth tip, and can occur at any age. Its size ranges from 0.5-2 cm, but can also more. When the cysts reach a large diameter, it can cause the face to be no symmetry because of the lump and may even cause paresthesias due to suppression of nerve by the cyst. In X-ray examinations radicular cyst will appear radiolucent bounded clear picture.
The general pattern of growth of a cyst is due to stimulation (cytokinase) on the remnants of epithelial cell growth and proliferation which then experienced in its growth does not invade surrounding tissue. The remaining epithelium will then proliferate to form a solid mass. Then the masses will be getting bigger so that the epithelial cells in the center of mass will lose blood flow, so that the flow of nutrients that occurs through a diffusion process will be interrupted. Death of cells in the center of mass will cause the cyst to form a fluid-filled cavity that is hipertonis. Hipertonis circumstances will cause the transudation of fluid from the extra lumen toward the lumen. The result is the hydrostatic pressure resulting in the growing mass of cysts. The process of enlargement of the mass of cysts can continue berlangsuung, sometimes until it can occur due to the expansion of mass parastesia mild nerve to suppress the onset of pain.
These cysts do not cause complaints or pain, except for an infected cyst. On radiographic examination, the cyst periapical dental granulomas show a picture like that is clearly bounded radiolucent lesion around the apex of the tooth in question and the edges like a thin layer of a compact such as the lamina dura.
Almost all radicular cysts derived from periapical granuloma that occurred previously. These cysts are also caused by continuing inflammation that occurs initially in the pulp, which then extends beneath the periapical tissues.
Pathophysiology of radicular cyst that is initiated from the pulp tissue inflammation that over time cause periapical inflammation. This inflammation stimulates the epithelial-rest malassez contained in the periodontal ligament resulting in periapical granuloma formation that can be infected or sterile. Finally, the epithelium had necrosis due to loss of blood supply and granuloma turn into cysts.
Residual cyst is a cyst caused by inflammation at the root fragments left behind when the revocation or the presence of residual granulomas that are not picked up during retraction. On clinical examination toothless jaws obtained by extraction and history had ever done in the radiology images found radiolucent image. In histopathological characterized by the presence of a cavity is covered with epithelium that did not experience keratinization squamosa and have varying thickness. Typically the process of inflammation can be seen by the discovery of many neutrophil cells in the cyst wall. Care is to do a residual cyst enucleation and generally does not occur recurrences.
Treatment consisted of root canal treatment or tooth extraction and cysts curettaged concerned. Can also be treated by means Marsupialisasi and enucleation.

Periapical granuloma

Periapical granuloma  Periapical granuloma is a lesion that is round with a slow development which is located near the apex of the tooth root, usually a complication of pulpitis. Consisted of chronic inflammatory tissue mass berprolifersi between fibrous capsule which is an extension of the periodontal ligament. It appears namely radiographic radiolucent image with a border that is sometimes visible on periapical. Generally spherical. Tooth in question will show the loss of lamina dura picture. Usually not accompanied by resorbsi roots, but some are showing a picture resorbsi roots.
Periapical granulomas can be caused by various irritants to the pulp which continues up to the tissues around the apex or on the periapical tissues. Irritants can be caused by organisms such as bacteria and viruses, and non-organism such as a mechanical irritant, thermal, and chemical.
Research conducted on specimens of periapical granulomas, mostly bacteria and facultative anaerobic organisms most often affects the Veillonella species (15%), Streptococcus milleri (11%), Streptococcus sanguis (11%), Actinomyces naeslundii (11%), Propionibacterium acnes ( 11%), and Bacteroides species (10%) .3 While the organism is a non-factor because of a mechanical irritant after root canal therapy, direct trauma, traumatic occlusion, and failure of endodontic procedures; and chemicals such as irrigation solution.
Dental granuloma is clinically indistinguishable from other lesions of periapical inflammation. To distinguish the other periapical lesions radiographic examination is required. Its size varies, ranging from the small diameter of only a few millimeters to 2 centimeters.
Dental granuloma consists of granulation tissue surrounded by a wall of fibrous connective tissue. In the dental granuloma that is long enough, tend to provide an overview of plasma cells, lymphocytes, neutrophils, histiocytes, and eusinofil, as well as epithelial cell rests of Malassez. In teeth with carious perforation in the microbiological examination will be obtained actynomices microaerophilic bacterium.
Pathological abnormalities caused by inflammation of the pulp reaction to last into the tissues around the apex. Pulpitis itself can be caused by infection with secondary caries, trauma, or failure of root canal treatment. Pulp necrosis will stimulate an inflammatory reaction in periodontal tissues tooth in question.
Pathophysiology of periapical granulomas can also be caused by various irritants to the pulp which continues up to the tissues around the apex or on the periapical tissues. Irritants can be caused by organisms such as bacteria and viruses, and non-organism such as a mechanical irritant, thermal, and chemical arising from necrotic pulp, the first deployment of the network periradikuler pulpal inflammation. Periapical granuloma is a continuation of acute periapical abscess. Iritannya include inflammatory mediators from the inflamed pulp irreversible or bacterial toxins from the necrotic pulp.
The underlying pathogenesis of periapical granuloma is an immune system response to maintain the periapical tissues to various irritants that arise through the pulp, which had metastasized to the periapical tissues. There are a variety of irritants that can cause inflammation of the pulp, the most common is due to bacteria, caries process that continues to make the entrance for the bacteria to the pulp, pulp hold a defense with an inflammatory response.
There are three main characteristics that affect the pulp inflammatory processes. First, the pulp can not compensate adequately for the inflammatory reaction is limited by the hard walls of the pulp. Inflammation will cause dilation of blood vessels and increase in tissue volume due to transudation of fluid. Second, although the pulp has a lot of vascularization, but only one is supplied by blood vessels that enter through a narrow channel called the apical foramen, and there is no other backup supplies. Edema of the pulp tissue will cause constriction of blood vessels that pass through the apical foramen, so that the pulp tissue is inadequate in defense mechanisms, especially the pulp tissue edema will cause the blood flow is interrupted, causing the pulp becomes necrotic. Room pulp and necrotic pulp tissue which will facilitate bacterial colonization. Third, because the teeth are on the jaw, then the bacteria will spread through the apical foramen into the periapical tissues.
Clinical symptoms of periapical granulomas and periapical cysts is very difficult to distinguish, usually patients do not complain of pain, and negative percussion tests. Therefore, the pulp that has been associated with necrosis, thermal stimulation would indicate a negative value. Radiographs will indicate the presence of radiolucent with clear boundaries. Although the radiographic examination is the key diagnostic, the only way to be able to distinguish them accurately is to use microscopic examination; histopathologic picture of periapical granulomas have been described previously, whereas periapical cyst histopathologic picture is characterized by the presence of a cavity is covered with epithelial type of non-keratinizing stratified squamous with varying thickness, the wall can be highly proliferative epithelium and showed plexiform arrangement. Typically the process of inflammation can be seen by the discovery of many inflammatory cells, namely lymphocytes and plasma cells in the cyst wall. Rousel body or round eusinophilic globule are found within or outside the plasma cells resulting in increased synthesis of immunoglobulin.
Periapical granuloma is a chronic inflammatory reaction around the tooth apex which is a continuation of the pulp inflammation caused by various irritants, such as bacteria, mechanical trauma, and chemicals. The underlying pathogenesis is the reaction of the body's immune system to the presence of irritants. Periapical granulomas are usually asymptomatic and found incidentally on radiographic examination as a radiolucent image, differential diagnosis including periapical cyst and periapical abscess, which can only be distinguished through microscopic examination. therapy can be performed by non-surgical endodontic treatment or surgery. The prognosis of periapical granuloma is good.
Dental granuloma generally do not cause symptoms for sure. Tooth in question would give a negative response to percussion, thermal tests, and electric pulp tests. In the continuing dental granulomas and left untreated can turn into a periapical cyst.
Apical inflammatory lesions generally caused by the toxic products produced by bacteria in the root canal, so the success of treatment depends on the elimination of bacteria on the teeth in question.
In the teeth can still be retained can be done perwatan root canal. While in dental restoration that can not be done then it should do the extraction. At the root canal-treated teeth should be evaluated in the first year and second to ascertain whether the lesions increase in size or have been cured.
Most of the periapical granuloma found incidentally during routine examination. Because of periapical granuloma is a continuation of pulp necrosis on physical examination will then be obtained negative thermal tests and EPT tests are negative. On radiographs of small-sized lesions that can not be separated clinically and radiographically. Periapical granulomas seen as a radiolucent image attached to the apex of the tooth root. A clear picture or a diffuse radiolucency bounded by a variety of sizes that can be observed with loss of lamina dura, with or without involvement of bone condensation.
The failure of the healing process usually caused by several things, among others:
- Changed the cyst formation
- Failure of root canal treatment
- Vertical root fracture
- The presence of periodontal disease
Clinical symptoms of periapical granulomas and periapical cysts is very difficult to distinguish, usually patients do not complain of pain, and negative percussion tests. Therefore, the pulp that has been associated with necrosis, thermal stimulation would indicate a negative value. Radiographs will indicate the presence of radiolucent with clear boundaries. Although the radiographic examination is the key diagnostic, the only way to be able to distinguish them accurately is to use microscopic examination; histopathologic picture of periapical granulomas have been described previously, whereas periapical cyst histopathologic picture is characterized by the presence of a cavity is covered with epithelial type of non-keratinizing stratified squamous with varying thickness, the wall can be highly proliferative epithelium and showed plexiform arrangement. Typically the process of inflammation can be seen by the discovery of many inflammatory cells, namely lymphocytes and plasma cells in the cyst wall. Rousel body or round eusinophilic globule are found within or outside the plasma cells resulting in increased synthesis of immunoglobulin

Periapical Abscess

Periapical Abscess . Periapical abscess is a localized collection of pus is limited by bone tissue caused by infection of the pulp or periodontal. Periapical abscess is generally derived from the pulp tissue necrosis. Infected tissues caused some cells die and disintegrate, leaving a cavity which contains tissues and cells that are infected. White blood cells which is the body's defense against infection, moving into the cavity and after memfagosit bacteria, white blood cells will die. White blood cells that die thus form pus that fills the cavity. This is due to accumulation of pus surrounding tissue will be encouraged and become an abscess wall. This is the body's defense mechanism to prevent the spread of further infection. If an abscess broke out in the infection could spread depending on the location of the abscess.
Cause Periapical abscess is the body fight infections with large numbers of white blood cells; pus is a collection of white blood cells and dead tissue. Usually the pus from a tooth infection was initially applied to the gums, so the gums near the tooth root to swell.
Pus can be drained to the skin, mouth, throat or skull, depending on the location of the affected teeth.
Periapical dental abscess symptoms of pain, pain when chewing may also arise. There might be a fever with swollen lymph nodes in the neck. If absesnya very heavy, then there is swelling in the jaw area.
People who have a low body resistance power, are at high risk for suffering from an abscess. Initially, the patient experienced abscess tooth pain that is getting worse. So that the nerves in the mouth can also be infected. If absesnya hidden in the gums, the gums can be colored red. To menterapinya, dentists make its way across the surface of the gum so that pus can run out. And when the pussy is getting way out, most of the pain suffered by patients is reduced drastically. If the abscess is not in the irrigation / drainage well, just broke. Then the infection had spread to other parts of the mouth can even spread to the neck and head.
The initial symptoms are the patient will feel a throbbing pain in the area that there is an abscess. Then the tooth will become more sensitive to heat and cold stimuli as well as pressure and mastication. Furthermore, patients will suffer from fever, lymph nodes in the lower jaw will feel more clot / slightly hardened and sore when touched. Patients also feel pain in the sinus area. If pus gets way out, or in other words the boil rupture, will cause bad smell and taste a little salty in your mouth.
Usually the dentist can diagnose the presence of abscesses in the oral cavity with a check directly. Your dentist can also perform diagnostics pulp, to find out whether your teeth are still vital or not. And to further ensure, dentists also take radiographs. Radiographic image of the abscess is evident in periapical radiolucent diffuse boundary.
Patofisologi: Generally caused by a bacterial infection of the caries process. With the development of caries, or a few antigens can cause the pulp tissue inflammation response. Therefore pulpal dentine covered by a dense structure then there is no room for expansion and inflammatory exudate through the root canal will spread to form a periapical abscess periapical tissues when the process of acute and chronic disorders will be a form of chronic abscesses, granulomas and radicular cysts.
Germs root canal is a major cause of periapical abscesses, and generally in the form of Gram positive, Gram-negative aerobes and anaerobes to be the invasion of periapical tissue and can eventually cause damage.
Patients with a periapical abscess may be with or without signs of inflammation, diffuse or localized. On examination percussion and palpation can be found the signs of sensitivity to varying degrees. Pulp does not respond to thermal stimulation because that has been associated with pulp necrosis. radiographs can vary from the periodontal ligament thinning until radiolucency lesion with unclear boundaries.
Abscess or cellulitis resolved by removing and disposing of pus infection through oral surgery or root canal treatment. To help eliminate the infection are often given antibiotics. The most important action is to repeal the pulp is exposed and removed nanahnya.
On roentgen examination will look at the picture of a diffuse boundary periapical radiolucent. Treatment is incision, drainage and antibiotics.