Complicated crown fracture with periapical disease

33 Complicated crown fracture with periapical disease


The crown fracture has exposed the pulp, resulting in pulpal inflammation. The teeth are mature, i.e. the apices are closed, so the injury must have occurred when the dog was more than 1 year old. The inflammatory response has spread to involve the periapical region, resulting in destruction of the periapical bone. This is evident as an apical rarefaction on a radiograph. The bone defect is filled with soft tissue, which may be granulation tissue (periapical granuloma), cyst (periapical or radicular cyst) or abscess (periapical abscess). Definitive differentiation between these three possibilities requires histopathology of the tissue. The periapical cyst usually occurs as a sequel to the periapical granuloma. It is a true cyst since the lesion consists of a pathological, often fluid-filled, cavity that is lined by epithelium. Periapical cysts enlarge due to the osmotic gradient set up between the lumen of the cyst and tissue fluids in the surrounding connective tissue. These lesions can become very large at the expense of the adjacent bone tissue, which is resorbed (due to pressure from the cyst). Periapical lesions may be entirely asymptomatic or excruciatingly painful. The periapical granuloma and periapical cyst rarely cause severe discomfort, but they may undergo exacerbation and develop into a periodontal abscess, which usually is an extremely painful condition.

Periapical disease as a consequence of pulpal inflammation is treated by removing the inflamed pulp. This can be achieved in one of two ways, either endodontic therapy (the pulp is removed, the debrided root canal is filled and the access cavities restored, and the tooth is maintained) or extraction of the affected tooth (the whole tooth is removed). The presence of periapical disease is not a contraindication for endodontic treatment. Once the inflamed pulp has been removed, the periapical bone will regenerate and the defect will heal.

Sep 3, 2016 | Posted by in SMALL ANIMAL | Comments Off on Complicated crown fracture with periapical disease
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