Periapical Radiolucencies
Dr Mohammed Malik Afroz
Format
 Periapical Granuloma
 Apical periodontal Cyst/Radicular Cyst
 Periapical abscess
 Periapical Scar
 Residual cyst
 Osteomyelitis
 Osteo Radio Necrosis
Specific Learning Objective
 To know the clinical and radiographic features of different
periapical diseases to be able to differentiate them
radiographically.
Introduction
 Focus of infection: circumscribed area of tissue which is
infected with exogenous pathogenic microorganisms &
which is usually located near a mucous or cutaneous
surface
 Focal infection: metastasis from the focus of infection of
organisms or their toxins that are capable of injuring
tissues
 Possible source of infection:
 Infected periapical lesions
 Periodontal diseases,etc…
Periapical Granuloma
 Etiology – A carious tooth.
 Clinical Features – seen in
individuals aged between 10 – 40
yrs
 Patient complains of dull,
continuous pain which increases
when he bites from the same area
 Patient feels more pain in the
night when he is lying down to the
side of infected tooth
Radiographic Examination
 An ill defines radiolucency
which is within the lamina
dura.
 There is very mild
widening of PDL space and
radiolucency is seen just
below the periapex
 Sometimes seen as a
radiolucency with diffuse
radiopacity at the apex of
the involved tooth
 If same feature is seen in
multi rooted tooth with
both the roots having small
radiolucency of less than 1
cm in diameter then it can
be considered as a
periapical abscess.
Treatment
 Deep caries management
 Root canal treatment.
APICAL PERIODONTAL CYST
Also called RADICULAR CYST
or
PERIAPICAL CYST
Most common Odontogenic Cyst
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Etiology
 Originating as a result
of bacterial infection &
necrosis of dental pulp
 Always following
carious involvement of
the tooth
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Clinical Features
 Common in younger age group and may range from 20-60yrs.
 Involves maxillary anteriors
 Deep carious lesion
 Tender on percussion
 Chronic inflammatory process develops only over a long
period of time
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Radiographic Features
 Exhibits a thin, radiopaque line around periphery of
radiolucent area
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Treatment & Prognosis
 Periapical tissue should be curetted while doing RCT &
followed by Apicoectomy
 Surgical removal
 If untreated- increase in size of cyst
- bone resorption
- expansion of cortical plates
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Clinical Features
 Often seen as sudden finding on routine radiograph.
 May get secondarily infected
 Discharge of purulent material through a sinus opening
 Patient may give a history of removal of an infected tooth.
 Patient does not have pain but may occasionally feel some
discomfort
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PERIAPICAL ABSCESS
Also called
DENTOALVEOLAR ABCESS
or
ALVEOLAR ABCESS
Acute/chronic suppurative
process of dental periapical
region
Acute exacerbation of
chronic periapical lesion is
called phoenix abscess
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Etiology
 It arises as a result of
infection following
carious involvement of
the tooth & pulp
infection
 Chemical application
during endodontic
treatment
 Traumatic injury to the
teeth & pulp necrosis
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Clinical Features
 Acute inflammation of apical peridontium
 Tenderness
 Tooth is extremely painful
 Systemic manifestation-
* Fever
* Regional lymphadenitis
* Osteomyilitis
 Thickening of periodontal ligament, expansion of
cortical plate
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Radiographic Features
 Seen as an ill defined radiolucency with
varying size.
 May involve one or more roots in a multi
rooted tooth.
 Radiolucency is more than 1cm in size
 Loss of lamina dura and radiolucency may
extend much beyond the apex
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Treatment & Prognosis
 Pus drainage by opening pulp chamber
 RCT
 Tooth extraction
 If untreated –
Osteomyelitis
Cellulitis
Bacteremia
Cavernous sinus
Thrombosis
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Periapical Scar
 Reason for periapical scar may be –
 asymptomatic apical periodontitis following
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root-canal treatment
Persistent intraradicular infection,
extraradicular
Infection (principally actinomycosis), foreign
body reaction
Related to the root filling material, the
accumulation of
Endogenous cholesterol crystals that irritate
the periapical
Tissue, true cystic lesions, and scar tissue
Radiographic Features
 An ill defined lesion seen in an
endodontically treated tooth .
 The radiolucency may be complete or
may have a left out filling material in it.
 It can be completely radiolucent or
partial.
 Hence follow up radiographs should be
taken to see the size of radiolucency
reduces after endodontic treatment
RESIDUAL CYST
 Accidentally discovered in an edentulous area
 Occurs after extraction of tooth leaving periapical
pathology untreated
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Radiographic Features
 It appears as round to ovoid radiolucency in alveolar ridge
 Lumen shows radiopacity indicative of dystrophic
calcification
 Lesion may not have intact borders.
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Treatment & Prognosis
 Cyst should be curetted thoroughly & lining should be
subjected to histopathological examination
 Do not re-occur if inflammatory foci near the cyst are
eliminated
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Thank You
 Any Questions????