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