The relationship of lesion size to diagnosis, incidence, and treatment of periapical cysts and granulomas

Nonsurgical Root Canal Therapy of Large Cystic Periapical Lesions Using Simple Aspiration and LSTR (Lesion Sterilization and Tissue Repair) Technique: Case Reports and Review

“…Studies strongly suggest that the incidence of cysts rises as lesion size increases. This, in turn, suggests that as the size of lesions increases, the reliability of radiographic differentiation may be significantly improved [9]. Lesion sizes of 200 mm or more, the incidence of cysts is at or close to 100%.…”

“…Nair et al examined 256 periapical lesions and found that 9% of them were apical true cysts and 6% were apical pocket cysts [7]. It is generally accepted that periradicular lesions cannot be differentially diagnosed as either radicular cysts or apical granulomas based on radiographic evidence alone [4,6] contrarily Natkin et al analysed data and stated that with a radiographic lesion size of 200 mm 2 or larger, the incidence of cysts was almost 100% [9]. If the lesion is separate from the apex and with an intact epithelial lining (apical true cyst), it may have developed into a self-perpetuating entity that may not heal when treated nonsurgically.…”

“…On other occasions, a large periradicular lesion may have a direct communication with the root canal system (apical pocket cyst) and respond favourably to nonsurgical treatment. There has also been a prolonged debate about the management of large cystic lesions, with some maintaining that true cysts cannot successfully treat by surgical means [8,9]. However, clinicians believe that a large majority of cysts will heal after nonsurgical root canal treatment [4,10].…”

Non Surgical Management of Large Periapical Lesions-A Report of Two Cases

“…However, some large lesions have been shown to be granulomas [12].The definitive diagnosis of a cyst can be made only by a histological analysis.…”

Using Periapical Radiography to Differentiate Periapical Granuloma and Radicular Cysts

“…In a report on 230 radiolucencies of teeth apex, 94% were related to periapical granulomas and only 6% to radicular cysts (2). Several studies are performed on radiographic differentiation of periapical granulomas and radicular cysts (3)(4)(5)(6)(7)(8)(9)(10)(11). Some of these studies try to show the difference between lesion sizes.…”