Clinicopathological characterization of 2,238 endodontic and nonendodontic periapical lesions.

Authors

Yuri Martins Barbosa, Stephany Pimenta Carvalho, Eneida Franco Vêncio, Carlos Estrela

Published in

Clinical oral investigations. Volume 30. Issue 9. Sep 04, 2026. Epub Sep 04, 2026.

Abstract

To determine the clinicopathological features of 2,238 endodontic and non-endodontic periapical lesions (PLs) retrieved from a database of an oral and maxillofacial pathology laboratory.
This retrospective cross-sectional study analyzed 12,441 histopathological records registered between 1956 and 2019. Of these, 2,238 cases diagnosed as PLs were selected. The lesions were classified as endodontic or non-endodontic, and clinicopathological variables, including microscopic diagnosis, sex, age, anatomical location, and lesion size, were evaluated.
During the study period, the laboratory recorded 12,441 lesions, of which 2,238 (18%) were PLs. Most lesions were of endodontic origin (2,073; 92.6%), whereas non-endodontic PLs accounted for 165 cases (7.4%). Among the non-endodontic lesions, odontogenic cysts were the most frequent (54.1%), followed by non-odontogenic cysts (14.3%). Malignant neoplasms comprised 2.3% of non-endodontic lesions and 0.2% of all PLs. Radicular cysts were the most common diagnosis (977; 47.1%), followed by periapical granulomas (827; 39.9%) and residual cysts (113; 5.4%). Most endodontic lesions measured less than 2 cm, although residual cysts were significantly larger. Non-endodontic PLs mainly included odontogenic keratocysts, nasopalatine duct cysts, and unicystic ameloblastomas, which showed a predominance in the mandible and larger dimensions. Overall, PLs were more frequent in women (mean age: 36.6 years) and predominantly affected the anterior maxilla.
Most of the 2,238 biopsy-confirmed PLs identified over 63 years were of endodontic origin, whereas a small proportion comprised non-endodontic and malignant lesions mimicking endodontic disease. Histopathological examination may be particularly important for persistent, enlarging, surgically treated, or clinically and/or radiographically atypical lesions.
This study demonstrates that although endodontic lesions predominate, non-endodontic, uncommon, and malignant lesions may mimic endodontic disease. Persistent, enlarging, surgically treated, or atypical periapical lesions warrant careful evaluation. Histopathological examination can establish a definitive diagnosis in selected cases and identify lesions that might otherwise be clinically or radiographically misclassified.

PMID:
42693222
Bibliographic data and abstract were imported from PubMed on 04 Sep 2026.

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