Acute apical periodontitis.. 20 years old male PT came with severe pain on chewing related to lower molars. Intraoral examination reveals no caries, good oral hygiene, no change in radiograph

20 years old male PT came with severe pain on chewing related to lower molars. Intraoral examination reveals no caries, good oral hygiene, no change in radiograph. PT give history of bridge cementation 3 days ago. Diagnosis: 
a- Pulp necrosis.
b- Acute apical periodontitis. ***
c- Chronic apical abscess.
d- None of the above.
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Acute apical periodontitis has been the subject of numerous denominations and classifications.
Although the periradicular qualifier includes inflammation of the furcal and lateral regions, from the etymological point of view, there is no distinction between periodontitis of pulp origin and marginal extension lesions.

Definition:
it is an acute and painful inflammation of the apical periodontal ligament, as a result of irritation, trauma or infection via the duct, regardless of whether the pulp is vital or not.
It is the acute inflammation of the periodontium, of endodontic origin, characterized by well-defined foci of neutrophils in the lesion.
It is considered primary when it is short-lived, and begins in a healthy periodontium, in response to various irritants.
It is called secondary when the response occurs in a preexisting chronic apical periodontitis lesion. The latter form is also known as periapical reactivation, exacerbation or "phenyx abscess."
Lesions can be epithelialized or non-epithelialized.

Cause:
Acute apical periodontitis, in a vital tooth, may be caused by occlusal trauma in restorations outside the occlusal plane, wedge engagement of foreign bodies between two teeth or by a blow on the tooth.
In the case of a non-vital tooth, it can be a sequel to pulpal diseases, root treatment, overstretching of filling materials, root perforation or over-instrumentation of the ducts.

Bacteriology:
The periapical area may be sterile, if the periodontitis was due to trauma or mechanical or chemical irritation or infected past an infected duct.

Histopathology:
Inflammatory reaction of the ligament, dilated vessels, leukocytes and serous exudate by extracting the tooth slightly. If the irritation continues the osteoclasts are activated.

Symptom:
tooth pain and tenderness bothering when occluding. History of endodontic treatment or prosthesis.

Diagnostic signs:
to the radiography widening the periodontal ligament space. Percussion pain and palpation. The tooth is extruded bothering the chewing.

Treatment:
determine the cause and improve symptoms, unclude the tooth and if there is exudate drain and dry the canal.

Forecast:
favorable for the tooth. The occurrence of acute apical periodontitis symptoms during endodontic treatment does not affect the final outcome of the treatment.
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