口腔组织病理学课件：根尖周病

Periapical Periodontitis
根尖周炎
Classi尖周炎
– acute急性 – chronic慢性
• chronic periapical abscess慢性根尖脓肿 • periapical granuloma根尖肉芽肿
Acute periapical periodontitis
• Clinical features
– Progression
• pain more intense疼痛加剧 • extreme sensitivity to chewing咀嚼痛 • the affected tooth extrude from its socket患牙伸长
扩散 • －－－－急性牙槽脓肿（急性化脓性根
尖周炎）
常见引流途径：
• 穿破骨膜经黏膜、皮肤排脓（唇颊侧牙 龈）
• 龋洞排除 • 深牙周袋排脓
Chronic periapical periodontitis
• Classification
– chronic periapical abscess 慢性根尖脓肿
– 慢性炎症细胞：Lymphocytic淋巴细胞 infiltrate intermixed with neutrophils中性白 细胞, plasma cells浆细胞, histocytes组织细 胞,等
Periapical granuloma
• Histopathologic features
on solid food – 多有龋坏或牙髓炎的病史（反复牙痛，反复
肿胀） – formation of fistulous瘘管形成 if the lesion
undergoes an acute exacerbation
• two types
– nonvital tooth（死髓牙）
Chronic periapical abscess
preparation
Periapical granuloma
• Histopathologic features
– another important feature -----the presence of epithelium
• origin
– the epithelial rests of Malassez – respiratory epithelium of the maxillary sinus – oral epithelium growing in through a fistulous tract – oral epithelium proliferating apically from a
– the pain is spontaneous自发, persistent持续 but is circumscribed局限
– indicate the affected tooth（准确定位）对叩诊 极度敏感
– 死髓牙
Acute periapical periodontitis
• Radiographic features X线表现
periodontal pocket
• epithelium stimulated by the inflammation
– extensive, sheets of stratified aquamous epithelium cell 复层鳞状上皮
吻合成网状、条索状
根尖周肉芽肿可能出现的变化
• Clinical features临床表现
– initial stage
• tenderness of the affected tooth患牙轻微疼痛 • relieved by direct application of pressure咬合压力
下缓解
sera squeezed out of the dilation扩张 blood vessels
根尖周间隙增宽，硬骨板不如正常清楚或 改变不明显
Acute periapical periodontitis
• Histopathologic features 组织学表现 • 炎症早期： • 血管扩张，浆液渗出，组织水肿，少量
中性粒细胞 • －－－－急性浆液性根尖周炎 • 进展期： • 大量中性粒细胞，形成脓肿，向牙槽骨
– 外周
纤维结缔组织
– 骨质吸收
Chronic periapical abscess
• 有瘘：被覆复层鳞状上皮 • 无瘘
Periapical granuloma根尖周肉 芽肿（最常见）
• Clinical features
– Asymptomatic（多无症状） – significant sensitivity to percussion（叩痛敏感） – nonvital tooth（死髓牙） – 咀嚼乏力或不适
• Radiographic features
– 根尖周呈现边界不规则的透射影 – 周围骨质呈云雾状
Chronic periapical abscess
• Histopathologic features
– the center 坏死液化 脓细胞
– around the pus 肉芽组织、慢性炎症细胞
慢性根尖周炎
Acute periapical periodontitis
• 深龋 牙髓炎 根尖周炎（死髓牙）
• 慢性根尖周炎急性发作（最常见）
• secondary to trauma外伤 • high occlusal contacts咬合创伤
Acute periapical periodontitis
Periapical granuloma
• Radiographic features:
– 牙周间隙增宽（小） – 界限清楚圆形透射影（大） – 硬骨缘：进行缓慢或稳定
Periapical granuloma
• Histopathologic features
– inflamed granulation tissue炎性肉芽组织 surrounded by a fibrous connective tissue wall
pulpal Necrosis牙髓坏死
Periapical inflammation 根尖周炎症
Periapical periodontitis
• Etiology
– bacterial effects 感染因素 derived from severe periodontitis重度牙周炎 deep periodontal pocket 深牙周袋
• 龋齿－牙髓炎－牙髓坏死（死髓牙）－ 根尖周炎（上皮性）－根尖周囊肿
Periapical cyst
• Clinical features
– no symptoms （多无症状） – nonvital tooth （死髓牙） – 好发部位：上颌切牙单尖牙 – 颌骨膨隆（大） – 10岁以下不常见
Periapical cyst
– sheers of foam cells泡沫细胞
• Phagocytes巨噬细胞 ingest lipid material and become collected in groups
– cholesterol crystals胆固醇结晶
• clear needle-like spaces or clefts microscopically • dissolving of cholesterol by the agents used in the
from dental procedures For example: in the root canal therapy根管治疗
the instrument or the filling materials were extruded the apical foramen
Periapical periodontitis
almost reach to the root apex
periapical diseases
Periapical periodontitis
• Etiology
– Mechanical damage 机械损伤
• traumatic accidents意外损伤 • occlusal trauma咬合创伤 • iatrogenic damage医源性损伤
Periapical cyst
• Histopathologic features
– 胆固醇结晶裂隙 – 泡沫细胞 – 含铁血黄素
• Histopathologic features
– the wall of the cyst
• dense fibrous connective tissue • often with an inflammatory infiltration
containing lymphocytes, neutrophils, plasma cells, histocytes, and mast cells and eosinophils
– periapical granuloma 根尖肉芽肿
Chronic periapical abscess慢性 根尖周脓肿（chronic alveolar abscess慢性牙槽脓肿）
– results from acute periapical abscess or periapical granuloma
Periapical periodontitis
• Classification according to the duration of disease 病程
– acute periapical periodontitis急性根尖周炎 – chronic periapical periodontitis
Chronic periapical abscess
• Clinical features
– asymptomatic （无明显自觉症状） – sensitivity to percussion （叩痛敏感） – mild pain occasioned when biting or chewing
• Radiographic feature
– radiolucency is well-circumscribed lesion and have a thin radiopaque line
– root resorption is common
Periapical cyst
• Histopathologic features • 囊壁衬覆无角化复层鳞状上皮 • 上皮细胞间水肿，上皮钉入增生，厚 薄不一
– lined with a pseudo-stratified ciliated columnar 假复 层纤毛柱状上皮or respiratory type of epithelium呼 吸道上皮 if involved the maxillary sinus上颌窦
Periapical cyst
• Etiology
– Chemical irritation化学刺激
• Most of them are iatrogenic • arise from the procedure of root canal therapy
根管治疗 For example:
irritative filling material
• 机体抵抗力强，病原刺激弱 • 炎症减弱，牙槽骨和牙骨质修复
• 病变缩小
根尖周肉芽肿可能出现的变化
• 根尖肉芽肿体积增大 • 肉芽肿中心营养缺乏，液化坏死
• 急性牙槽脓肿 • 迁延为慢性牙槽脓肿
根尖周肉芽肿可能出现的变化
根尖周囊肿 致密骨炎（年轻患者）
Periapical cyst
• 最常见的牙源性囊肿
• periapical cyst根尖周囊肿
Periapical periodontitis 根尖周炎
• Etiology
– bacterial effects 感染因素 most of them derived from pulpitis绝大多 数 继发于牙髓炎
Caries龋齿
Pulpitis (Acute or chronic)牙髓炎