1. PERIAPICAL GRANULOMA (CHRONIC APICAL PERIODONTITIS)

2. No true granulomatous inflammation microscopically.
a mass of chronically inflamed granulation tissue at the apex of a nonvital tooth.
No true granulomatous inflammation microscopically.
a defensive reaction secondary to the presence of bacteria in the root canal
These lesions are not static ………….periapical cysts or
abscess formation.
approximately 75% of apical inflammatory lesions

3. A radiolucency of variable size
loss of the apical lamina dura.
circumscribed or ill-defined.

4. Root resorption is not uncommon
chronic low-grade inflammatory reaction will result in root resorption

5. Incomplete root canal therapy

6. Vitality test ……….. to eliminate the possibility of osseous dysplasia.
Trauma devitalized two of these teeth
Vitality test ………..
to eliminate the possibility of
osseous dysplasia.

7. granulation tissue Histopathologic Features
inflamed granulation tissue surrounded by a fibrous connective tissue wall.
granulation tissue
a variably dense lymphocytic infiltrate that is intermixed frequently with neutrophils, plasma cells, histiocytes, and, less frequently, mast cells and eosinophils .
number of young capillaries surrounded by a mixed inflammatory reaction

8. Granulation tissue with intense chronic inflammation

9. Foam cells

10. Granulation tissue is not a component in all cases of chronic apical periodontitis.
In older lesions you may see more fibrosis.

11. Russell bodies
numerous plasma cells are present, scattered eosinophilic globules of gamma globulin

12. Collections of cholesterol clefts with associated multinucleated giant cells
Cholesterin deposits indicate cellular degeneration.

13. red blood cell extravasation with hemosiderin pigmentation