Chronic periapical periodontitis containing mature human hair shaft: a case report

Periapical periodontitis refers to inflammation and destruction of periradicular and/or periapical tissues, the most common cause being endodontic infection resulting from pulpal necrosis. Other causes can be trauma or endodontic treatment.1^,2 A chronic periapical periodontitis may present as a discharging sinus, a tooth which is tender to percussion, or may be asymptomatic and discovered on routine clinical examination.3 The associated tooth is non-vital.3^,4 Periapical radiolucencies are common and 90% are attributed to chronic periapical periodontitis or periapical cysts.4Table 1 gives a differential diagnosis of periapical radiolucencies.

Radiographic appearances of chronic periapical periodontitis vary from slight widening of the periodontal ligament space to a well defined radiolucency. A condensing osteitis is often associated with the lesion owing to the formation of sclerotic bone in reaction to continued inflammation.3^,10 Radicular cysts (inflammatory dental cysts) are characterized as radiolucencies measuring greater than 1 cm in diameter and are a direct sequela of chronic periapical periodontitis.3 A radiographic image can only lead to a provisional diagnosis and histological examination should be utilized to establish a definitive diagnosis.11