By Dr. Vishaal Bhat on Saturday, 29 December, 2007 with 0 comments

Periodontitis is characterized by spreading an infection into the periodontium. They are caused mostly by the root canal infection that proceeds into periodontium through foramen apicale or through ramifications in the apical area. Among other causes there may be traumas (both chronic and acute), chemical effects (devitalization or disinfecting agents).

Periodontitis acuta is characterized by dilatation of vessels near the root apex and an edematous infiltration of periapical tissues. According to the extent of inflammatory changes, an acute periodontitis has the following stages:

  • at the periodontal phase, the inflammation is located at the apex area

  • for the enosseal phase, the serous exudation and formation of a cellular infiltrate with a pus colliquation are characteristic

  • at the subperiosteal phase, the inflammatory process spreads under the periosteum of an alveolar ridge

  • after the periosteum necrosis the pus containing exudate leaks under a mucosa; the submucosal phase is accompanied by formation of an abscess that sometimes empties spontaneously by an intra-oral fistula.

An acute periodontitis often originates by exacerbation of a chronic periodontitis due to decrease of an organism’s immunity or after a treatment of an infected root canal. After examination of the oral cavity, a doctor formulates a diagnosis and makes it more specific after an X-ray examination. A physician can identify an aching tooth and the apical area sensitivity upon percussion. It is also possible to find a submucous tissue infiltration, eventually redness, swelling and fluctuation at a vestibule surrounding the affected tooth. At more developed cases, enlargement of regional lymph nodes occurs and the patient’s general condition is altered, often accompanied by a fever. Pain is severe during the early phases of the inflammation. After the submucosal infiltrate or a fistula are formed, an obvious pain relief comes. The aim of the acute periodontitis treatment is to ensure that an exudate may flow away from the periapical area. This may be achieved by a tooth trepanation (at periodontal and enosseal phases) and by making a passage through the root canal. A patient feels a distinct relief after this treatment. At the subperiosteal and submucosal phases, the tooth trepanation has to be complemented by an intra-oral incision. Antibiotics should be prescribed if a patient’s general state is altered and an elevated body temperature occurs. After acute problems are relieved, further treatment is applied as in the case of diagnosis of periodontitis chronica.

Periodontitis chronica. The underlying cause of the disease is formation of a granulomatous tissue at the tooth apex area. The course of the disease is either in the form of a non-limited, diffuse process (periodontitis chronica diffusa) or it tends to be localized (periodontitis chronica circumscripta). A focus is then encapsulated by a fibrous membrane, with small abscess cavities or a single continuous abscess cavity inside. Mallas├ęz’s epithelial cells, remnants of the Hertwig’s sheath occurring during the tooth development, can often be found. These cells grow as a result of an inflammatory irritation and form clusters of epithelial cells - an epithelial granuloma.

At periodontitis chronica granulomatosa progresiva, the granulomatous tissue spreads into surrounding structures and mucosal, even cutaneous fistulas arise. If the process affects the upper jaw near the antrum, an antral fistula may be formed. Chronic periodontitis usually runs with no clinical difficulties and it is diagnosed by an X-ray examination. An X-ray image shows large or small, diffuse or sharp-edged radiolucency around the tooth apex. A mucosal fistula can be sometimes found next to an affected tooth. A chronic inflammation may also exacerbate acutely, causing obvious difficulties. The treatment for a necrotic, gangrenous pulp and for chronic periodontitis is by conservative or surgico-protective means.

Conservative therapy relies on a mechanical widening of the root canal, treatment of a microbial infection and filling the root canal with a filler that prevents re-infection and allows for healing of periapical tissues.

At the surgico-conservative therapy, the root canal is filled with the zinc oxide - phosphate cement, after a previous root canal treatment. The surgery - tooth apex resection (apicectomy, amputation) - the basis of which is an removal of a treated tooth apex, excochleation of the granulomatous tissue followed by a toilet of the bone wound.

Category: Periodontics Notes



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