Peculiarities of the root growth zone and differential diagnosis of granulomatous apical periodontitis

Abstract

Introduction: Chronic apical periodontitis, as the last evolution stage of an untreated pulp disease, has the area of development in the periapical dental space, an important zone from the cellular point of view infected with bacteria. The large number of chronic apical periodontitis cases encountered in daily dental practice, especially in younger patients, requires an accurate assessment of the periapical status changes caused by the microbial activity. The question is the correct diagnosis of the growth zone from an apical chronic inflammatory process, because the clinical and laboratory similarities can contribute to an erroneous diagnosis. Purpose: The study of the structural features of the growth zone of the root apex and the differential diagnosis between the non-edified root and radicular granuloma in the permanent young teeth. Analysis of bibliographic data on the subject. Radiological study of the permanent teeth with the root non-edified apex at different stages of evolution.Comparative analysis on the base of radiological data of the growth zone and radicular granuloma. Materials and methods: 97 radiological clichés of children from 5 to 17 years with the roots of teeth in different stages of formation and 12 radiograms with radicular granulomas have been studied. Macroscopically, 20 teeth, extracted for various reasons, with unformed roots were studied. Results and discussion: Analysis of radiological data of the tooth roots revealed the pecularities of the growth zone in comparison with the destructive changes characteristic for the chronic granulomatous periodontitis in the form of extended centre of rarefaction with the bone missing in the middle, the periodontal space widening on the account of the cortical lamina resorption and the absence of the spongiosa involved in the inflammatory process. Conclusions: Inflammation and pulp necrosis disturb the process of development of young permanent teeth roots, especially that the inflammatory processes in children are diffuse, affecting the adjacent tissues of the centre. Chronic apical periodontitis, occurring especially in younger patients, requires an accurate assessment of the periapical changes.