In this Article, we will describe and state a differential diagnosis for the most common Periapical radiolucent lesions that means that the lesion is located in the periapical region and appears radiolucent. This article is similar to Periapical radiolucent lesions: Non-Pulpal Orginis.The diffrence is the origin is pulpal, thus When we say pulpal origins it means the tooth is non-vital.

Case Questions 

Here are some Case questions :D… try to express the differential diagnosis (at least 3).

1.  A Periapical lesion of an endo treated tooth, shows well defined radiolucency

Periapical Radiolucent Lesions of Pulpal Origins

Definitions

• Periapical: comes from the words peri: around and apical:root.
• RL: Radiolucent: it express that the region/area/object didn’t absorb the radiation but it’s transparent/translucent thus more radiation reaches the sensor/film leading to a darker area. (Low mineral content: Tissue other than bone).
• RO: Radiopaque: it express that the region/area/object  absorbed the radiation thus less radiation reaches the sensor/film leading to a lighter area. (High Mineral Content: Bones and teeth).
• Unilucular: From the words uni: means one and lucular means lobes, it means the lesion appears as one mass.
• Monolucular: From the Words Mono: means multiple. it means the lesions appears as multiple mass in one lesion area.
• Corticated: means the lesion contains an outer cortex thus it appears with radiopaque outer boarder.

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Periapical Granuloma

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Features:

• Most Common
• Small round or oval RL
• Surrounds the Apex of tooth
• May be well circumscribed boarders

Differential Diagnosis:

• Cemntoma 1^st stage.
• Apical Abscess.
• Surgical Defect.
• Ridiculer Cyst.
• Traumatic Bone cyst.

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Radicular Cyst

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Features:

• Liquid filled cavity lined by epithelium.
• Develops from a pre-existing Periapical Granuloma.
• The radio-opaque boarder is continuous with lamina dura of the effected tooth, thus the apex can be identified within the lesion.
• The adjacent teeth can be displaced and rarely resorbed.

Differential Diagnosis:

• Traumatic bone cyst. “solitary”
• Cementoma 1^st stage.
• Surgical Defect.
• Periapical Granuloma.
• Periapical scar.

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Surgical Defect

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Description:

• Pulp-less tooth
• Well Defined
• Size is constant for years

Features:

• An area in which it fails in being filled with osseous tissue.
• Composed of dense fibrous tissue.
• Situated at apex of Pulp-less tooth.
• Asymptomatic.

Differential Diagnosis:

• Periapical Granuloma.
• Radicular cyst.
• Apical Abscess.
• Apical Scar.

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Apical Abscess

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Features:

• Acute:
  • Acute Apical Abscess is -associated with deep carious lesion.
  • No Radiographic evidence.
  • Except widening of PDL space.
  • After a week, Further development of the abscess into a diffuse radiolucency may occur.
• Chronic:
  • Chronic Might arise from:
    • Acute apical abscess.
    • Periapical Granuloma.
    • Radicular Cyst.
  • A diffuse Periapical radiolucency of different size.
  • Loss of lamina dura at the apex may be present.

Differential Diagnosis:

• Periapical Granuloma.
• Radicular Cyst.
• Osteomyelitis.

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Osteomyelitis

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Description: Moth-Eaten radiolucency

Features:

• An Inflammation of the bone marrow. Usually from dental infection.
• Acute phase:
  • Is rapid with no radiographic signs (in the first 8-10 days)
  • If untreated might turn into :
• Chronic Phase:
  • Bone destruction.

Differential Diagnosis:

• Apical Abscess.
• Periapical Granuloma.
• Radicular Cyst.

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Answers

1. Answer Question:  Peripaical Granuloma, Apical Scar, Surgical Defect.