Periapical Granuloma vs. Radicular Cyst: Clinical & Radiographic Features Explained for Dentists

Periapical Lesions

Clinical Features of Radicular Cyst

Incidence: Radicular cyst constitutes about 50% or more among all types of jaw cysts.
Age: Mostly third, fourth and fit decade of life.
Sex: More common among males.
Site: The cyst can occur in relation to any tooth of either jaw, but maxilla (60%) is more commonly affcted than mandible (40%).

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Periapical Granuloma vs Radicular Cyst – Clinical and Radiographic Features

Differential Diagnosis Of Periapical Radiolucencies

Involved toothisalwaysnon-vitaland canbe easilydetected by the presence of caries, fractures or discolorations, etc. Moreover, the affcted tooth does not respond to thermal electric pulp testing.
Cyst becomes more symptomatic as there is acute exacerbation of the periapical inflmmation.
Larger lesions on the other hand, oftn produce a slow enlarging, bony hard swelling, of the jaw with expansion and distortion of the cortical plates or disturbance in occlusion mostly of the regional teeth; maxillary lesions may cause either buccal or palatal cortical expansions whereas the mandibular lesions oftn cause buccal or labial expansions and rarely the lingual expansions.

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Periapical Radiolucencies Diagnosis

Severe bone destruction by the cystic lesion results in thinning of the cortical plates and it may produce a “springiness” of the jawbone when digital pressure is applied.
There may be presence of flctuations in case the bone is completely eroded by a large cyst.
These lesions clinically appear blue as they lie close to the overlying epithelium since the bone has been completely resorbed.

Difference Between Periapical Granuloma and Radicular Cyst

Pain may be present in the cyst, if it is secondarily infected and it may result in the development of either intraoral or extraoral pus-discharging sinuses.

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Periapical Radiolucencies And Inflammation

On rare occasions, there may be occurrence of paresthesia or pathological fractures in the bone, etc.
Occasionally, radicular cysts can be multiple in numbers, occurring in relation to several teeth or in relation to several roots of a multirooted tooth.
A radicular cyst may persist in the jaw aftr the attched tooth has been extracted; such cyst is often called a ’residual cyst’. These cysts frequently cause swelling in the dentulous jaws and they regress slowly and spontaneously.

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Radiographic Diagnosis of Periapical Lesions – Granuloma vs Cyst

In some cases, radicular cysts may develop at the opening of a large accessory pulp canal on the lateral aspect of the tooth root; and these cysts are often termed as ’lateral radicular cysts’.
If the cyst is secondarily infected it leads to the formation of an abscess, which is called “cyst abscess”.

Radiographic Features of Radicular cyst

It appears as a rounded or pear-shaped radiolucency at the apex of nonsensitive tooth or with nonvital tooth.
Radiolucency is more than 1.5 cm in diameter but usually less than 3 cm in diameter. It has got well-defied outline with thin hyperostotic borders.

Clinical Features of Radicular Cyst vs Periapical Granuloma

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Margins: In uncomplicated cases, margins are smooth, corticated and cortex is usually well-defined, welletched and continuous, except in some cases, there may be window formation

Periapical Radiolucencies Treatment

There is also thin white line surrounding the margins of bone cavity. This thin layer of cortical bone is almost always present unless suppuration supervenes in the cyst.
Image of radiopaque borders is continuous with lamina dura around the associated tooth. Infection may cause the borders to become less distinct.
Radicular cysts of long duration may cause resorption of roots.
Adjacent teeth are usually displaced and rarely resorbed. There is also buccal expansion and involves maxillary area than displacement of antrum occurs.