Periapical central giant cell granuloma: A potential endodontic misdiagnosis

This retrospective study ascertained the incidence and clinicopathologic fe atures of central giant cell granulomas (CGCGs) associated with teeth with necrotic pulps or teeth that had received previous endodontic treatment and determined whether periapical CGCGs can result in endodontic misdiagnosis. Clinical and histopathologic data of biopsy specimens diagnosed as CGCG we re collected from the archives of the Oral Pathology Laboratory, Temple Uni versity, and were reviewed. Over the 9-year period, 16 of 79 cases (20%) of CC;CC were associated with a tooth that had a history of pulp necrosis. Of those, 14 (88%) were associated with previous root canal treatment. The da ta from this series of 79 cases of CGCG also showed that CGCGs were less co mmon in women, less common before age 30, and did not cross the midline of the jaw as often as previously reported. Clinical and histopathologic data were compared from (1) CGCGs associated with teeth With vital pulps or that occurred in edentulous areas; (2) CGCGs associated with teeth with necroti c pulps; and (3) 194 cases of periapical granulomas and radicular cysts. Th ese data strongly suggest that CGCGs associated with teeth with necrotic pu lps are not directly related to periapical inflammation and may be misdiagn osed as endodontic lesions. Posttreatment follow-up and routine submission of periapical surgical specimens are emphasized.