17/12/2025
đźš« Sequelae of Pulpal Inflammation: From Chronic Apical Periodontitis to Severe Periapical Complications
Pulpal inflammation is a dynamic pathological process that, when left untreated, can lead to a wide spectrum of periapical sequelae. The image clearly illustrates how pulpal disease may evolve through chronic or acute pathways, each associated with distinct clinical and radiographic outcomes that are highly relevant in daily dental practice.
🔹 In the chronic pathway, persistent low-grade inflammation of the dental pulp often progresses to chronic apical periodontitis, characterized by periapical bone resorption as a result of long-standing microbial irritation. Over time, this condition may further develop into a periapical granuloma, representing a localized inflammatory tissue response. If epithelial proliferation occurs within this granulomatous tissue, it can ultimately give rise to a periapical cyst, one of the most advanced chronic sequelae of pulpal inflammation.
🔸 In contrast, the acute pathway reflects a rapid and aggressive inflammatory response. Acute pulpal infection may spread beyond the apex, resulting in a periapical abscess, often associated with pain, swelling, and systemic involvement. If the infection extends into the surrounding bone and soft tissues, it may progress to osteomyelitis, which can present in different forms, including chronic osteomyelitis, cellulitis, or Garré’s osteomyelitis, particularly in younger patients.
👉 Understanding the sequelae of pulpal inflammation is essential for early diagnosis, appropriate treatment planning, and prevention of severe complications. Timely endodontic intervention remains the cornerstone to interrupt disease progression and preserve both dental and systemic health.