Apical Granuloma
What is an Apical Granuloma?

When a tooth dies, it may become very slightly tender to
touch but otherwise shows little in the way of symptoms.  
The ‘dead’ tooth may develop a low-grade infection around
the root tip (known as a
Chronic Apical Periodontitis) which
often follows an acute infection that has been inadequately
drained and incompletely resolved.

Chronic Apical Periodontitis is a typical chronic
inflammatory reaction.

The infection is confined by inflammatory cells and a mass
of new blood vessels, scar material and various types of
immune cells (known as
granulation tissue).

The granulation tissue grows into a rounded mass at the
root tip, an
Apical Granuloma.
Radiograph of a Peri-Apical Granuloma
Why does it happen?

Despite the absence of symptoms, there is no spontaneous healing due to the
persistence of the infection from the dead tooth.  Instead, the granulation tissue
proliferates around the root tip and the surrounding bone undergoes resorption
(breakdown / destruction and subsequent loss), thus increasing the area that the
granuloma can expand into.

Proliferation at the root tip can ultimately lead to cyst formation.

Apical granulomata usually remain localised in the bone, however abscess
formation and pus may reach the gum surface and present as a
gum boil’ / parulis.

Possible Complications of Chronic Apical Periodontitis

How is it treated?

Healing and resolution of the apical granuloma only follows adequate endodontic
treatment of the tooth or after an
apicectomy or after tooth extraction.

Useful Websites:

LSU Health Sciences Center School of Dentistry

Dr Guido
Last Updated 24th June 2011