Differential Diagnosis Of Periapical Radiolucencies

Differential Diagnosis Of Periapical Radiolucencies

Lesions representing as periapical radiolucencies

True Periapical Radiolucent Lesions

That are truly in contact with the apex of the tooth.

• Pulpoperiapical radiolucencies
  • Periapical granuloma
  • Radicular cyst
  • Periapical scar
  • Periapical abscess
  • Surgical defect
  • Osteomyelitis
  • Hyperplasia of sinus mucosa
  • Periapical cemental dysplasia
  • Acute apical periodontitis
  • Traumatic bone cyst
  • Dentigerous cyst
  • Non-radicular cyst
  • Benign and Malignant tumors including secondary metastatic deposits
  • Giant cell granuloma
  • Lymphoreticular tumors of bone

Read And Learn More: Oral Radiology Question And Answers

False (Anatomic Periapical Radiolucencies)

Produced by anatomic cavities or lytic bony lesions that do not contact the apex of tooth.

These radiolucent shadows are shifted from periapex by taking additional periapical radiographs at different angles:

• Mental foramen
• Focal osteoporotic bone marrow defects
• Dental papilla
• Incisive foramen
• Maxillary sinus
  • About 30–60% of bone loss must have occurred for a change to be detected on radiographs.

Differential Diagnosis

• Periapical granuloma
  • Periapical scar: Here involved tooth shows appearance of filing of root canal.
  • Cementoma: During osteolytic stage of cementoma the tooth becomes vital while in granuloma tooth becomes non-vital.
  • Radicular cyst: During FNAC straw-colored fluid is not obtained from periapical granuloma while straw color fluid is seen in cyst.
• Periapical cyst or radicular cyst
  • Periapical granuloma: During FNAC straw-colored fluid is obtained from cyst while in granuloma flid is not present. Borders of cyst are hyperostotic.
  • Periapical cementoma: During early stages, involved tooth is vital in granuloma while it is non-vital in cyst.
  • Lateral periodontal cyst: When site ofthe radicular cyst is same as for lateral periodontal cyst, the confusion can be eliminated as the involved tooth is vital in lateral periodontal cyst while it is non-vital in periapical cyst.
  • Traumatic bone cyst: This occurs mostly in mandible, while it is not true for periapical cyst.
  • Periodontal abscess: The Associated tooth is vital in abscess and bone loss is seen.
• Non-radicular cyst
  • Primordial Cyst: No history of extraction of tooth is depicted by the patient in primordial cyst. Seen in younger individuals and in posterior region of mandible.
  • Keratocyst: Size ofthe cyst is much greater as compared to residual cyst. Residual cyst is unilocular while the keratocyst can be multilocular. Seen in posterior region of mandible.
  • Ameloblastoma: Larger in size and can be multilocular. Diameter of ameloblastoma is much greater than residual cyst.
• Periapical abscess
  • Periodontal abscess: Periodontal abscess is mostly associated with periodontal pocket and pain. The involved tooth is vital.
  • Foramina: In foramina, lamina dura appears to be intact while it is not intact in abscess.
  • Marrow space: While taking radiograph, if marrow space get imposed with apex of root, continuity of lamina dura should be detected.
  • Periapical osteofirosis: This is associated with the vital tooth while abscess is associated with non-vital tooth.
• Osteomyelitis
  • Paget’s disease: In this, almost all the bones except few are affcted while in osteomyelitis affcted bone is involved.
  • Eosinophilic granuloma: In osteomyelitis, margins are poor while margins are well defied in eosinophilic granuloma as compared to osteomyelitis.
• Acute apical periodontitis
  • Radicular cyst: The Tooth is non-vital in radicular cyst while it is vital in periodontitis.
  • Periapical abscess: It is not associated with periodontal pocket while periodontitis is associated with pocket formation. Associated tooth is non-vital in periapical abscess, while it is vital in acute apical periodontitis.
• Periapical cemental dysplasia
  • Pulpoperiapical lesions: Radiolucent area involving most commonly the lower incisors and is not associated with dental caries but it can be suspected as periapical cemental dysplasia. Mostly pulpoperiapical lesions are associated with the dental caries.
  • Ossifying firoma: Seen in younger individuals and is seen most commonly in the premolar area, while periapical cemental dysplasia is most commonly associated with the incisor area.
  • Atraumatic bone cyst: This is extensive in size as compared to periapical cemental dysplasia. Atraumatic bone is mostly seen in younger individuals.
  • Cementoblastoma: Seen commonly in mandibular molar or premolar area.
• Traumatic bone cyst
  • Radicular cyst: A Tooth associated with the traumatic bone cyst is vital, while the tooth associated with a radicular cyst is non-vital.
  • Ameloblastoma: Radiographic appearance in traumatic bone is unilocular while it is multilocular in ameloblastoma.
  • Central giant cell granuloma: In traumatic bone cyst the internal bony septae are absent while in central giant cell granuloma internal bony septae are present.
  • Eosinophilic granuloma: Traumatic bone cyst is corticated while eosinophilic granuloma is non-corticated.
• Dentigerous cyst
  • Adenomatoid odontogenic tumor: The lesion is associated more commonly with maxillary anterior region while dentigerous cyst is associated with impacted canines and third molars.
  • Ameloblastoma: Ameloblastoma is multilocular. Ameloblastoma extends laterally away from tooth while dentigerous cyst encircles the tooth.
  • Odontogenic keratocyst: OKC does not undergo bony expansion and also not resorb teeth and is placed more apical to the tooth as compared to dentigerous cyst.
  • Radicular cyst: In primary teeth, it gives appearance of dentigerous cyst. So it is mandatory to look for caries in such cases.
• Giant cell granuloma
  • Ameloblastoma: It is multilocular, seen in middle age, more susceptible in posterior aspect while giant cell granuloma is unilocular, seen in younger age and is more susceptible in premolar area.
  • Traumatic bone cyst: Expansion of bony cortex is not present in traumatic bone cyst while it is seen in giant cell granuloma.
  • Odontogenic myxoma: Associated with the impacted tooth and on radiographic examination, it is multilocular while giant cell granuloma is not associated with impacted tooth and is mostly unilocular.