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Granulomatous periodontitis
Last reviewed: 07.07.2025
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Granuloma is one of the forms of apical periodontitis, which develops as a consequence of the granulation process. Granulomatous periodontitis is clinically manifested less actively than its predecessor - granulation periodontitis.
Pathogenetic mechanism of development:
- Granulation tissue begins to grow into areas near the root apex.
- The peripheral borders of granulation are transformed into a granuloma – a fibrous capsule.
- In the apex (top) of the root, parts of the root cementum and dentin remain.
- Those areas of the root that are in contact with the capsule are covered with small neoplasms and accumulations of excess cement.
Granulomatous periodontitis differs according to the structure of granulomas:
- Simple connective tissue granuloma.
- Epithelial capsule in which granulation tissue alternates with epithelial strands.
- A cyst-shaped granuloma with an epithelial cavity.
[ Symptoms of granulomatous periodontitis
Clinical symptoms of granulomatous periodontitis:
- Long asymptomatic development of granulomas.
- The location of the capsules is most often observed on the sides of the root apex.
- The presence of a painless bulge in the area of the alveolar process in the projection of the root apex.
- Gradual and steady increase in granuloma.
- The aggravation of the process is accompanied by the destruction of the dental alveoli.
- There may be mild pain when pressing on the affected tooth.
How to recognize granulomatous periodontitis?
Diagnosis of the granulomatous process is most often accidental, when the patient visits the dentist for another reason - dental restoration, filling, etc. Granulomatous inflammation is differentiated from a periradicular cyst, although its radiographic visualization is specific enough to make the correct diagnosis.
Treatment of granulomatous periodontitis
A granuloma is essentially a cyst, so treatment of granulomatous periodontitis involves neutralizing the contents of the cysts, stopping the inflammation process and possible excision of the granuloma tissue.
Effective treatment of granulomatous periodontitis involves at least three visits to the dentist, the stages of therapy are as follows:
- First visit to the doctor. Examination and diagnostics of the oral cavity, periodontium, examinations (X-ray). Instrumental treatment and cleaning of the canal, irrigation and sanitation of the canal with antimicrobial agents. Introduction of medicinal material into the tooth cavity and placement of a temporary filling.
- Second visit to the doctor. The root apex is opened to ensure the outflow of purulent contents or accumulated exudate. Enzymes, antiseptics, and hyposensitizing agents are used in the treatment of the granuloma.
- Third visit to the dentist. If the exudate drains successfully and there is no infectious obturation of the canal, a permanent filling may be installed. Before this, the canal is sanitized again, and its condition is monitored using X-rays. It should be noted that the peculiarity of granulomatous periodontitis therapy is that if the cyst is quite large, it is excised during the first visit.
The prognosis for the treatment of granulomatous periodontitis is very favorable; treatment rarely ends with tooth extraction or gum incision. Of course, a favorable outcome of therapy is possible only with timely assistance, and this primarily depends on the patient.