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Roentgenographic Appearance of Periapical Granuloma
D IA G N O S IS O F F O C A L IN F E C T IO N . . . V O L U M E 42, J U N E 1951 • 635
iginating outside o f the tooth from ( 1 ) trau m atic occlusion, ( 2 ) lack o f occlusion, or (3 ) lack o f proxim al contact. T h e thickening o f the periodontal membrane takes place long be fore alveolar absorption begins. It usually is accom panied by a thickening o f the lamina dura which then appears as a broader, more irregular white line.
Respecting the actual width (not nec essarily the roentgenographic appear ance) of the periodontal membrane Zander4 states: “ Measurements o f a large number o f cases range from 0.08 to 0.38 mm. Even in embedded teeth the perio dontal space does not disappear although it reaches its smallest diameter in such teeth.” R O E N T G E N O G R A P H IC A P P E A R A N C E O F P E R IA P IC A L G R A N U L O M A
Kronfeld5 states that “ A granuloma may vary in size from a pin-head to 8 or 10 mm. or even larger, depending upon the length of its duration and the intensity of the inflammation.” H e points out other roentgenographic characteristics of the periapical granuloma: “ The apex is sur rounded by a sharply outlined area of bone destruction and the root end pro jects into this radiolucent area. The rest o f the periodontal space appears intact.” H e points out also that the portion of the root surface located within the granu loma may show resorption. Grossman6 points out: “ The area of rarefaction is rather well defined, being bounded by a fine, not always continuous, radiopaque line which is indicative of dense bone in contradistinction to a chronic abscess where the rarefied area is diffuse and fades into the surrounding bone.” In regard to the differential diagnosis, he continues: “ In some cases . . . the periapical tissue is in a transitional stage between chronic abscess and granuloma, and an exact diagnosis is difficult. The area o f rarefaction should also be differ entiated from that of a cyst. In the latter the area is delimited by a fine, white con
tinuous line. . . . An additional point of differentiation is that a cyst commonly attains a larger size than a granuloma.” M cCall and W ald7 note: “ The radicu lar cyst is essentially an epitheliated gran uloma. As the epithelium proliferates, a cavity is created by accumulation of fluid and the cyst grows to accomodate the gradually increasing fluid contents. As it grows it causes resorption o f the sur rounding bone; the wall of the bony cavity thus formed is called the cortical layer.” DEVELOPM ENT OF
CEM ENTOM A
Morgan,8 after a study o f a large series of patients, concluded: “ The occurrence of cementoma in man is not an uncom mon finding. The cementoma is rarely significant, only insofar as misinterpreta tions are made. The growth usually re mains relatively small, the teeth affected invariably remain vital and removal rarely is justifiable. . . Stafne,9 studying 78 teeth in 35 pa tients, found that 69 of the teeth involved were mandibular incisors. He found, further, that the teeth were vital and had a normal color in every instance. Histo logic sections of one root-end area dis closed a well defined connective tissue capsule enclosing a mass of connective tissue and bone spicules the inner portion of which was a compact mass of fused cementicles. He concluded that periapical infection plays no part in these forma tions. McCall and W ald10 agree: “ In cases of cementoma there is bone destruction and replacement by fibrous connective tis sue. In later stages cementum is formed which appears as a central radiopaque mass often resembling bone; it is sur rounded by fibrous tissue, this constituting a radiolucent zone. It is more common in the mandible than in the maxilla. . . . The etiology is not known with cer tainty.” Thom a11 discusses the cementoblas-
iginating outside o f the tooth from ( 1 ) trau m atic occlusion, ( 2 ) lack o f occlusion, or (3 ) lack o f proxim al contact. T h e thickening o f the periodontal membrane takes place long be fore alveolar absorption begins. It usually is accom panied by a thickening o f the lamina dura which then appears as a broader, more irregular white line.
Respecting the actual width (not nec essarily the roentgenographic appear ance) of the periodontal membrane Zander4 states: “ Measurements o f a large number o f cases range from 0.08 to 0.38 mm. Even in embedded teeth the perio dontal space does not disappear although it reaches its smallest diameter in such teeth.” R O E N T G E N O G R A P H IC A P P E A R A N C E O F P E R IA P IC A L G R A N U L O M A
Kronfeld5 states that “ A granuloma may vary in size from a pin-head to 8 or 10 mm. or even larger, depending upon the length of its duration and the intensity of the inflammation.” H e points out other roentgenographic characteristics of the periapical granuloma: “ The apex is sur rounded by a sharply outlined area of bone destruction and the root end pro jects into this radiolucent area. The rest o f the periodontal space appears intact.” H e points out also that the portion of the root surface located within the granu loma may show resorption. Grossman6 points out: “ The area of rarefaction is rather well defined, being bounded by a fine, not always continuous, radiopaque line which is indicative of dense bone in contradistinction to a chronic abscess where the rarefied area is diffuse and fades into the surrounding bone.” In regard to the differential diagnosis, he continues: “ In some cases . . . the periapical tissue is in a transitional stage between chronic abscess and granuloma, and an exact diagnosis is difficult. The area o f rarefaction should also be differ entiated from that of a cyst. In the latter the area is delimited by a fine, white con
tinuous line. . . . An additional point of differentiation is that a cyst commonly attains a larger size than a granuloma.” M cCall and W ald7 note: “ The radicu lar cyst is essentially an epitheliated gran uloma. As the epithelium proliferates, a cavity is created by accumulation of fluid and the cyst grows to accomodate the gradually increasing fluid contents. As it grows it causes resorption o f the sur rounding bone; the wall of the bony cavity thus formed is called the cortical layer.” DEVELOPM ENT OF
CEM ENTOM A
Morgan,8 after a study o f a large series of patients, concluded: “ The occurrence of cementoma in man is not an uncom mon finding. The cementoma is rarely significant, only insofar as misinterpreta tions are made. The growth usually re mains relatively small, the teeth affected invariably remain vital and removal rarely is justifiable. . . Stafne,9 studying 78 teeth in 35 pa tients, found that 69 of the teeth involved were mandibular incisors. He found, further, that the teeth were vital and had a normal color in every instance. Histo logic sections of one root-end area dis closed a well defined connective tissue capsule enclosing a mass of connective tissue and bone spicules the inner portion of which was a compact mass of fused cementicles. He concluded that periapical infection plays no part in these forma tions. McCall and W ald10 agree: “ In cases of cementoma there is bone destruction and replacement by fibrous connective tis sue. In later stages cementum is formed which appears as a central radiopaque mass often resembling bone; it is sur rounded by fibrous tissue, this constituting a radiolucent zone. It is more common in the mandible than in the maxilla. . . . The etiology is not known with cer tainty.” Thom a11 discusses the cementoblas-