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

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