Periapical granulomas: a clinicopathological study of 128 cases

Introduction: Periapical granulomas are the most common sequelae of pulp diseases. Objectives: This retrospective study evaluated the clinical and histopathological features of 128 periapical granulomas. Materials and Methods: One hundred and twenty-eight periapical granulomas sent to a private pathology laboratory by dentists in private dental clinics were collected from September 2005 to October 2009. Clinical data and histopathological features of these lesions were reviewed and analyzed. Results: These 128 periapical granulomas were taken from 128 patients (39 men and 89 women, mean age 43.1 years). Periapical granulomas (66 cases, 51.6%) occurred more frequently in patients between 30 and 49 years of age. One hundred periapical granulomas were found in the maxilla and 28 in the mandible. The most common site was the maxillary anterior region (73 cases) and the most frequently involved teeth were the maxillary central (34 cases) and lateral incisors (29 cases). All periapical granulomas were composed of granulation or fibrous tissue with an infiltrate of acute and/or chronic inflammatory cells. Odontogenic epithelial rests, cholesterol clefts, foamy histiocytes, hemosiderin-laden macrophages, dystrophic calcifications, foreign bodies, and bacterial clumps were found in 5, 3, 9, 2, 28, 10 and 1 periapical granulomas, respectively. Conclusions: We conclude that periapical granulomas occur more frequently in female patients and in patients in the fourth to fifth decades of life. Periapical granulomas are more commonly found in the periapical areas of the maxillary central and lateral incisors in this series.