By depertement of dental radiology

PRINSIP UMUM
Radiolucent/Radiopaque lession pada apek akar
Beberapa lesi periapikal:Awal:radiolusen radiopak
Penyebab paling banyak :pulpa nekrosis akibat
karies gigi
Pada diagnosis kelainan periapikal sangat penting
untuk menilai vitalitas dari gigi

List of disease
1. Periodontitis apikalis
2.Periapical abscess
3.Periapical granuloma
4.Periapical cyst
5.Fibrous healing defect
6.Hipercementosis
7. Focal Sclerosing Osteomyelitis
(condensing osteitis)

SEKEMA PATOGENESIS KELAIANAN PERIAPIKAL

AKIBAT KELAINAN PULPA
JEJAS
(fisik, kimia, mikroorganisme)
PERMUKAAN GIGI SEHAT /PULPA
PULPITIS REVERSIBLE
ASYPMTOMATIS

Bila tidak dirawat

SYMPTOMATIS

PULPITIS KRONIS PROLIFERATIF

PULPITIS IREVERSIBLE
Bila tidak dirawat
RESORPSI INTERNA

NEKROSIS

PENY. PERIRADIKULER
PERIODONTITIS APIKALIS
ASYMPTOMATIS
ABSES PERIAPIKAL KKRONIS

SYMPTOMATIS
ABSES PERIAPIKAL AKUT

GRANULOMA PERIAPIKAL
KISTA PERIAPIKAL

GAMBARAN RADIOGRAFI PERIAPIKAL YANG

PENTING UNTUK ACUAN INTERPRETASI:
Radiolucent line dari periodontal ligament space
Normal : Thin continuous black line melingkari
akar gigi
Radiopaque line dari lamina dura
Normal: Thin, continuous.
Pola trabekula dan densitas tulang sekitar:
- Mandibula: cortec cendrung lebih tebal, trabekula
lebih rapat arah horisontal
- Maksila:Cortec Lebih tipis, trabekula lebih longgar

PERIODONTITIS APIKALIS AKUT (PAA)

Akibat lanjut infeksi pulpa(pulpitis/nekrosis),

traumatic occlusion, over instrument/overfilling,

bahan irigasi dan sterilisasi SA
Klinis :- Gigi vital/non-vital, perkusi , tekanan
- Karena pulpitis : peka terhadap dingin, panas
dan elektrik
- Nyeri saat mengunyah
Radiograf:
pelebaran space periodonsium bagian apikal

PERIAPIKAL ABSCESS ........

Sinonym: apical periodontal abscess
1,1 % dari kelainan periapikal radiolusen
Etiology
1. Acute inflamatory process containing neuthrophils
and necrotic debris (pus)
2. Develops at the root apex of the pulp necrotic

Typical Radiographic Features:

- Cirkumscribed radiolucent at the root apex,
berbatas difuse
- Kontinuitas lamina dura terputus
- Occasionally : be displaced laterally
- The tooth show: deep caries, large restoration or
endodontic theraphy

Clinical : - Asymptomatic,

- nonvital
- perkussion : painful
- advance : fistula

Differential Diagnosis
1. Periapical Granuloma
2. Periapical Cyst
3. Focal sclerosing osteomyelitis (early lession)
4. Periapical cemento-osseus dysplasia

Clinical Significance
Untreated Ostemyelitis

PERIAPICAL GRANULOMA
Sinonym : Chronic apical periodontitis
adalah pembentukan jaringan granulasi sebagai
respon pertahanan terhadap infeksi periapikal yang
tidak dirawat
48% kelainan periapikal yang radiolusen
Dapat terjadi transformasi kistik
Clinical : - Gigi non-vital
- Asymptomatic
- Percussion, tekanan : not be painful

 Typical Radiographic Feature:

- Cirkumscribed radiolucent at the root apex,

distinc border
- Kontinuitas lamina dura terputus
- Occasionally : be displaced laterally
- The tooth show: deep caries, large restoration
or endodontic theraphy

DD/: 1. Periapical abscess

2. Periapical cyst
3. focal sclerosing osteomyelitis (early lession)
4. Periapical cemental dysplasia
5. Simple bone cyst

Clinical Significance
acute exacerbation Periapical abscess

PERIAPICAL CYST.

Sinonym

: radicular Cyst

Etiology

The odontogenic epithelium originates from the rest

of malassez
43% kelainan periapiak
Clinical: - The tooth: nonvital,
- Asymptomatic,
- Percussion&tekanan: not be painful

 Typical Radiographic Features ;

- Cirkumscribed radiolucent at the root apex,

distinc border with radiopaque lining margin

- Kontinuitas lamina dura terputus
- Occasionally : be displaced laterally
- The tooth show: deep caries, large restoration
or endodontic theraphy

DD/: 1. Abses periapikal

2. Granuloma periapikal
3. Periapical cemental dysplasia (early lession)
4. focal sclerosing osteomyelitis (early
lession)
5. Simple bone cyst

FIBROUS HEALING DEFECT .

adalah lesi diperiapikal akibat
tindakan kuretase pd perawatan
apek reseksi terjadi ruang
kosong
Klinis : gigi non vital
Radiographic features :
- Radiolusen lebih pekat bulat /
oval pada apikal
- Akar gigi Ada bekas
pemotongan
- Retrograde restoration

FOCAL SCLEROSING OSTEOMYELITIS

(initially lession)

Syinonim
- Condensing Osteitis
- Focal chronic Sclerosing Osteomyelitis
- Sclerosing Osteitis/Bone Scllerotic

Etiology
Inflamation (Chronic osteomyelitis) that develops at the
root apex of toot with chronic pulpitis

Clinical
- The most common in mandibular premolar or molar
- Asymptomatic, or chronic pain of low intensity

 Typical Radiogrphic Feature

Cirkumscribed radiolucent at the root apex with a
deep caries lession

Clinical Significance
With time calcified radiopaque appearance

EARLY LESSION

ADVANCE LESSION

HIPERCEMENTOSIS
terjadi karena produksi sementum yang berlebih akibat respon
peradangan periapikal
dapat terjadi karena beberapa faktor etiologi
Sering ditemui secara insidental (tidak sengaja) pada pem.
radiografi
Sering pada Px tua
radiograf;
- Pembesaran apikal gigi seprti bola lampu / alat pemukul
(clubbing root end)
- Kadang outline asli akar masih dapat diamati dalam masa
hipersementosis tersebut
- Lamina dura dan space periodonsium masih utuh dan jelas
- Gigi supra erupsi