A Clinical, Roentgenographic, and Histopathologic Evaluation of Periapical Lesions.

D IAGNOSIS of periapical areas of rarefaction has always been a problem to the oral surgeon and general practitioner. A review of the literature reveals few studieF of apical roentgenolucent areas in the last 10 years. These investigations have concerned themselves mainly with teeth that have had extensive restorative and endodontic treatment. A study was undertaken to (I) evaluate, roentgenographically and clinically, areas of periapical rarefaction in persons who have never sought definitive dental treatment and (2) evaluate histopathologically the specimens obtained from these areas. Periapical roentgenolucent areas are usually diagnosed as cysts, granulomas, or chronic periapical abscesses. However, a differential diagnosis including, among others, Paget’s disease, eosinophilic granuloma, fibrous dysplasia, HandSchiiller-Christian disease, and neoplasms should be kept in mind. Criteria for the roentgenologic diagnosis of periapical pathoses have received considerable attention in the literature. McCall and Wald4 have defined a cyst as a circumscribed radiolucent area, usually more than 3/S inch in diameter, sharply outlined, and bound by a thin, even, white line which represents a layer of cortical bone. A granuloma has been defined as a definite radiolucency without the presence of a white line and usually less than 3/s inch in diameter. A chronic periapical abscess appears as a diffuse radiolucent area, usually accompanied by resorption of the root end of the involved teeth. Stafne5 also stated that the roentgen image of a dental granuloma is generally not as definite or as well demarcated as the small, fully developed cyst. He further states that granulomas and radicular cysts of equal size cannot be distinguished roentgenographically from each other. Granulomas, however, seldom exceed 1 cm. in diameter. The accuracy and validity of roentgenologic diagnosis of periapical lesions