Radiographic Features
Common Periapical Lesions
1. Apical Periodontitis
2. Acute & Chronic Periapical Abscess
3. Periapical Granuloma
4. Periapical Cyst
5. Periapical Rarefying & Condensing Osteitis
6. Periapical Condensing Osteitis
Uncommon Periapical Lesions
1. Periapical cemental dysplasia - 3 stages
(periapical osteofibrosis)
2. Hypercementosis
3. Cementoblastoma
4. Periapical scar
False Periapical Lesions
Anatomic landmarks or pathologies arising from the basal bone
that are superimposed over the root apex.
1. Large marrow spaces
2. Incisive / mental foramen
3. Lateral / canine fossa
4. Cysts and benign tumors of jaw bones
5. Localized / generalized sclerosing osteomylitis
Radiographic Features of Common Periapical Lesions
Dental Caries
Pulpitis
Radiographic Appearance
Pulp Necrosis
Apical
Periodontitis
Widening of PDL space
or
Loss of lamina dura
at the root apex
Radiographic Features of Common Periapical Lesions
Dental Caries
Pulpitis
Radiographic Appearance
Pulp Necrosis
Apical
Periodontitis
Acute
Periapical Abscess
Rarefaction of alveolar
bone i.e. thinning of
trabecular pattern
Radiographic Features of Common Periapical Lesions
Dental Caries
Pulpitis
Radiographic Appearance
Pulp Necrosis
Apical
Periodontitis
Chronic
Periapical Abscess
Grayish
Dark irregular
irregularradiolucency
radiolucencyin
in periapical alveolar bone
sometime with a radiopaque zone
around the periphery
Radiographic Features of Common Periapical Lesions
Widening of
PDL space
Loss of lamina
dura at the apex
Apical Periodontitis
Radiographic Features of Common Periapical Lesions
Apical Periodontitis
Radiographic Features of Common Periapical Lesions
Acute Periapical Abscess
Rarefaction of alveolar bone i.e. thinning of
trabecular pattern
Radiographic Features of Common Periapical Lesions
Chronic Periapical Abscess
Gray irregular radiolucency in
periapical alveolar bone.
Radiographic Features of Common Periapical Lesions
Chronic Periapical Abscess
Sclerosis of
peripheral bone
Dark irregular radiolucency in
periapical alveolar bone sometime
with a radiopaque zone around
the periphery.
Radiographic Features of Common Periapical Lesions
Dental Caries
Pulpitis
Radiographic Appearance
Pulp Necrosis
Apical
Periodontitis
Periapical Granuloma
Well-defined round or oval
radiolucency in the periapical
alveolar bone usually without a
hyperostotic border and not more
than 1.6 cms in diameter
Radiographic Features of Common Periapical Lesions
Dental Caries
Pulpitis
Radiographic Appearance
Pulp Necrosis
Apical
Periodontitis
Well-defined
round
radiolucency in the
alveolar bone with a
hyperostotic border and
1.6 cms in diameter
Periapical Granuloma
Periapical Cyst
(apical periodontal / radicular cyst)
or
oval
periapical
radiopaque
more than
Radiographic Features of Common Periapical Lesions
Periapical
Granuloma
Well-defined round or oval
radiolucency
in
the
periapical alveolar bone
usually
without
a
hyperostotic border and
not more than 1.6 cms in
diameter.
Radiographic Features of Common Periapical Lesions
Periapical Granuloma
Radiographic Features of Common Periapical Lesions
Periapical Cyst
(apical periodontal / radicular cyst)
Well-defined round or oval radiolucency in the
periapical alveolar bone with a radiopaque
hyperostotic border and more than 1.6 cms in
diameter.
Radiographic Features of Common Periapical Lesions
Periapical Cyst
(apical periodontal / radicular cyst)
Partial loss of the hyperostotic border is indicative
of secondary infection. Such a cyst is called as an
infected periapical cyst.
Radiographic Features of Common Periapical Lesions
Periapical Cyst
(apical periodontal / radicular cyst)
Radiographic Features of Common Periapical Lesions
Dental Caries
Pulpitis
Radiographic Appearance
Pulp Necrosis
Apical
Periodontitis
Periapical Rarefying &
Condensing Osteitis
Ill-defined irregular radiolucency in
the periapical alveolar bone
surrounded by an irregularly
outlined radiopacity
Radiographic Features of Common Periapical Lesions
Dental Caries
Pulpitis
Radiographic Appearance
Ill-defined irregular radiopacity in
the periapical alveolar bone
Pulp Necrosis
Apical
Periodontitis
Periapical
Condensing Osteitis
Radiographic Features of Common Periapical Lesions
Periapical Rarefying & Condensing Osteitis
Periapical lesion secondary
to advanced periodontal
disease
Ill-defined irregular radiolucency in the periapical
alveolar bone surrounded by an irregularly outlined
radiopacity.
Radiographic Features of Common Periapical Lesions
Periapical Condensing Osteitis
Ill-defined irregular radiopacity in
the periapical alveolar bone.
Radiographic Features of Common Periapical Lesions
SEQUELAE OF PULPITIS & INTERRELATIONSHIPS
Apical Periodontitis
Acute Periapical Abscess
Chronic Periapical Abscess
Periapical Granuloma
ATTENTION
Periapical Cyst
The interrelationships among these periapical lesions
often makes their radiographic appearance different
from the typical text-book description.
Radiographic Features of Common Periapical Lesions
Radiographic Description of a Lesion:
Radiolucent
Radiopaque
Mixed
~ Site
~ Size
~ Shape
~ Outline - regular / irregular, scalloped
~ Borders - well- / ill - defined, hyperostotic
~ Contents - mixed lesions
~ Additional features - root resorption / displacement,
hanging / floating teeth appearance, soap-bubble /
honeycomb appearance, ground glass appearance,
cotton wool appearance, etc.
Radiographic Features of Common Periapical Lesions
1. Apical Periodontitis: Appears either as loss of lamina dura
or as widening of the PDL space at the periapex of the tooth.
2. Acute Periapical Abscess: Appears as rarefaction of the
alveolar bone at the periapex. Rarefaction means thinning of
the trabeculae and increase in the size of the marrow spaces
due to accumulation of inflammatory exudate. The
trabecular pattern, however is not disturbed. The outline is
irregular and the borders are ill-defined.
Radiographic Features of Common Periapical Lesions
3. Chronic Periapical Abscess: Appears as a small to large
grayish radiolucency with irregular, ill-defined borders. As
the inflammation persists further resorption of the alveolar
bone causes the radiolucency to change from a grayish
shadow to a black one.
In chronic long-standing infections the lesion tends to
become regular in outline and well-defined. A radiopaque
zone with irregular outline may also develop around the
radiolucency (sclerosis).
Resorption of the root apex may sometimes be seen.
Radiographic Features of Common Periapical Lesions
4. Periapical Granuloma: Appears as a round or oval
radiolucency with regular outline and well-defined border. A
hyperostotic border may sometimes be evident. The shadow
is usually around 8 to 10 mm in diameter and does not
become larger than 1.6 cms.
The affected tooth may appear elevated out of the socket and
the root apex may show resorption.
An infected granuloma shows partially ill-defined border.
Radiographic Features of Common Periapical Lesions
4. Periapical Cyst (Apical Periodontal Cyst, Radicular Cyst):
Appears as a round or oval radiolucency with a regular outline
and a well-defined border. A hyperostotic border is evident
surrounding the radiolucency. The shadow is usually larger than
1.6 cms. in diameter. An infected cyst shows partially corticated
border.
As the cyst enlarges additional features become evident :
displacement of adjacent roots
expansion of the jaw bone, usually labially / buccally
expansion of the inferior border of mandible
thinning of the cortical plate
perforation of cortical plate > cyst-in-cyst appearance
Radiographic Differential Diagnosis
of Common Periapical Lesions
The same features that are used for description of a lesion radiographically
are used for differential diagnosis.
Size
Abscess
Granuloma
Cyst
Any size
Not more than
1.6 cms
More than
1.6 cms
Shape No shape
Round or oval
Round or oval
Outline
Irregular
Regular
Regular
Border
Ill-defined
Well-defined
Well-defined &
hyperostotic
Other
Features
Root
resorption
Tooth elevated
Expansion
Root
Thinning
displacement
ofofcortex
jaw
Cyst-in-cyst
appearance
