Histopathological Evaluation of Granulation Tissue in Chronic Periapical Lesions After Surgical Curettage: A Prospective Study

Chronic periapical lesions are common inflammatory pathologies of odontogenic origin that develop due to persistent pulpal infection and periapical tissue response. These lesions may present clinically with pain, tenderness, swelling, sinus tract, or persistent radiographic radiolucency. Although clinical and radiographic evaluation helps in diagnosis, definitive differentiation between periapical granuloma, radicular cyst, and abscessed granuloma requires histopathological examination. Evaluation of surgically curetted granulation tissue is therefore important for accurate diagnosis and clinicopathological correlation. The aim of this study was to evaluate the histopathological features of granulation tissue obtained from chronic periapical lesions after surgical curettage at a tertiary care hospital. This prospective observational study included 52 patients with clinically and radiographically diagnosed chronic periapical lesions requiring surgical curettage. Detailed clinical evaluation and radiographic assessment were performed before surgery. Following surgical curettage, the excised granulation tissue was fixed in 10% neutral buffered formalin and processed for routine histopathological examination using hematoxylin and eosin staining. The specimens were evaluated for final histopathological diagnosis, intensity of inflammation, predominant inflammatory cells, vascular proliferation, fibroblast proliferation, collagen deposition, and presence of epithelial lining or rests. Data were analyzed using IBM SPSS Statistics version 27.0. Categorical variables were expressed as frequency and percentage, and associations were assessed using chi-square test or Fisher’s exact test. A p-value of less than 0.05 was considered statistically significant. The age of patients ranged from 18 to 62 years, with a mean age of 36.85 ± 11.42 years. The highest number of cases was seen in the 31–40 years age group (34.62%). Females were slightly more affected (53.85%) than males (46.15%). Maxillary lesions were more common (59.62%) than mandibular lesions (40.38%), and anterior teeth were most frequently involved (55.77%). Pain or tenderness on percussion was present in 65.38% of cases, and periapical bone destruction was observed in 73.08%. Histopathologically, periapical granuloma was the most common diagnosis (69.23%), followed by radicular cyst (17.31%) and abscessed granuloma (13.46%). Moderate and severe inflammation were each observed in 46.15% of cases. Gender showed no significant association with histopathological diagnosis (p=0.97), whereas intensity of inflammation showed a statistically significant association with lesion type (p=0.02). Periapical granuloma was the predominant histopathological diagnosis among chronic periapical lesions after surgical curettage. Histopathological evaluation is essential for accurate diagnosis, assessment of inflammatory activity, and clinicopathological correlation.