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Periapical granuloma is one of the most common of all sequelae of pulpitis. It is essentially a localised mass of chronic granulation tissue formed in response to the infection. The involved tooth is sensitive to percussion, and the patient feels pain while chewing solid food. The sensitivity is due to inflammation of the apical periodontal ligament. The radiographic appearance is similar to, but smaller than, a periapical cyst. Histologically, the lesion is composed of predominantly plasma cells mixed with lymphocytes and macrophages with proliferating fibroblasts and endothelial cells.

Figure 1: Periapical granuloma. Fig. 1A: Mandibular Occlusal X-ray showing well-defined periapical radiolucency in relation to the mandibular anterior teeth which is suggestive of periapical granuloma or periapiclal cyst. Fig. 1B: 3-D reconstructed CT image of a patient with periapical granuloma.
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