There is a mixed infiltrate consisting of lymphocytes, plasma cells and occasionally histiocytes and neutrophils.

This periapical granuloma has a fibrous wall lined by squamous epithelium and thus would be better classified as a periapical cyst.

As with a periapical granuloma, granulation tissue with a prominent lymphoplasmacytic infiltrate is present.

Periapical granulomas represent 75% of apical inflammatory lesions. It is actually not a true granuloma. This condition describes the mass of inflamed granulation located at the root (apex) of a nonvital tooth, and thus, the term chronic apical periodontitis may be a more accurate description.

Histologically, it consists of granulation tissue with a mixed inflammatory infiltrate. There may be a prominent presence of plasma cells with Russell bodies (eosinophilic globules of gamma globulin). If a true epithelium forms, then the entity may be called a periapical cyst or radicular cyst.

These lesions are usually asymptomatic, but pain and tenderness may occur if there is an acute exacerbation. On imaging, there is a discrete radiolucent area surrounding the root of the tooth.

Removing the infected portions of the tooth pulp via root canal and antibiotics are the key treatment strategies.