Grossman's Classification

INTRODUCTION

It's well known that pulpal infections result in pulp necrosis and if left untreated will most likely lead to periapical pathologies due to irritant leakage ( be it microbial, defective restoration material etc.), trauma, improper endodontic treatments, or diseases of non-endodontic origin. In this assignment, systemic diagnosis of several periapical lesions will be discussed along with their treatment plan and prognosis.

CLASSIFICATION OF PERIAPICAL PATHOLOGIES

Several classifications have been established, 3 of which are most commonly referred to: Grossman's classification, WHO classification, and Ingle's classification of pulpoperiapical pathosis.

Grossman's classification:

1. Acute periradicular disease

2. Chronic periradicular

Not tender upon percussion

c. No mobility

d. No response to thermal/electric pulp test

e. Lesions are discovered on routine x-rays as a well or poorly defined radiolucent lesion with possible root resorption

Treatment and Prognosis:

a. In restorable tooth, RCT is performed

b. In non-restorable tooth, extraction and curettage are preferred.

V. RADICULAR CYST

Etiology:

a. Caries

b. Irritants from restorative material

c. Trauma

d. Pulpal death from developmental defects

Signs and Symptoms:

a. Usually asymptomatic and discovered in routine x-ray

b. Slowly growing and reach a large size

c. Involved teeth are usually non-vital with discoloration, fracture or failed RCT.

d. The cyst appears round, pear or ovoid shaped radiolucency on x-ray with a thin radio-opaque margin.

Treatment:

a. Endodontic treatment

b. Apicectomy

c. Extraction in case of severe bone loss

d. Enucleation with 1ry closure

e. Marsupilization with larger ones

VI. CHRONIC ALVEOLAR ABSCESS

Etiology:

a. Pulpal necrosis

b. Associated with chronic periapical periodontitis and abscess

Signs and Symptoms:

a. A sinus tract is usually common opening into the oral cavity

b. Generally asymptomatic

Diagnosis:

a. History of sharp pain that subsided and hasn't

Sinus tract resolves after RCT

VII. EXTERNAL ROOT RESORPTION

3 types are common: apical, lateral and cervical root resorption.

Etiology:

a. Infected necrotic pulp tissue

b. Over-instrumentation during RCT

c. Adjacent impacted tooth

d. Trauma

e. Granuloma/cyst

Signs and Symptoms:

a. Asymptomatic

b. Mobile root after complete resorption

c. Pink tooth is observed if the resorption reaches the crown

Diagnosis:

a. Pink discoloration

b. Radiographic findings show loss of lamina dura

c. Irregular shortening of root

d. Radiolucency at the root and adjacent bone

Treatment and Prognosis:

a. Remove stimulus causing the inflammation

b. Surgical/non-surgical RCT should be performed according to the case

c. Resorption usually stops after treatment, internal bleaching may be performed for esthetic reasons.

VIII. DISEASES OF PERIRADICULAR TISSUE OF NON-EDONTOGENIC ORIGIN

Benign Lesions:

a. Ossifying fibroma

b. Myxoma

c. Ameloblastoma

d. Solitary bone cyst

e. Lateral periodontal cyst

f. Central hemangioma

g. Central giant cell granuloma

Diagnosis:

a. Teeth are vital

b. Surgical biopsy is necessary for final diagnosis

Malignant Lesions:

a. Squamous cell carcinoma

b. Multiple myeloma

c. Chondrosarcoma

d. Osteogenic sarcoma