PERIAPICAL

GRANULOMA
• These lesion represent between 69.7-94% of all pulperiapical lesion
• This is the result of A succesful attempt by a periapical tissue to
neutralize and confime the irritating toxic products that are escaping
from the root canal
Microstructure consist of grnuloma consist of
-proliferating endothelial cell
-Capillaries
- Young fibroblast
- Minimum amount of collagen
- Chronic inflammatory cells( lymphocytes, plasma cells, macrophages)
- Russell bodies,foam cells, cholestrol cleft
Features

• Features
• -Well circumscribed radiolucency Some what rounded
-May have a hyperostositic border
- Cyst tend to be larger Than granuloma
- Pulp of the offending tooth test nonvital
- Swelling or expansion of socket is not applicable

-
Radicular cyst
- Secondly most common pulpo-periapical lesion
- It represent about 6-25.9%
- It is classifies as an inflammatory Cyst
 DIFFERENTIAL DIAGNOSIS
• If 1.6cm or more Likely to be a cyst( In practice, it is unnecessary to
differentiate between small periapical granulomas and cysts, since
both respond well to conservative root canal therapy)
• a persistent, asymptomatic, nonenlarging radiolucency is most likely a
periapical scar
• Similarly, an asymptomatic radiolucencyy that persists after root
resection is likely a surgical defect.
• The periapical cementoosseous dysplasia (PCOD) (cementoma) in its
early lytic and fibroblastic stage cannot be distinguished from a
periapical granuloma or cyst by radiographic exexamination. However
the pulp is vital and healthy.
• Although a traumatic bone cyst in a periapical vital may be mistaken
for a dental granuloma or cys(as with PCOD, the pulps of the
associated vital are usually vital.
PERIAPICAL SCAR
• It is a dense fIbrous tissue Sitauted at the periapex of
a pulpless too in which usually the root canals have
been usually filled
• It represent previous periapical granuloma,cyst, or
abscess whose healing has been terminated in the
form of dense scar tissue(cicatrix) rather than bone
• From 2-5% all periapical lesions are estimated to
periapical scars
• FEATURES
-it is frequently smaller than either of these entity
- It occurs most often in the anterior region of maxilla