Which feature is associated with a periapical granuloma?

• A. Continuous with the periodontal ligament at the tooth apex.
• B. Contained within a closed fibrous capsule not connected to the PDL.
• C. Always radiopaque on imaging.
• D. Lumen is fluid-filled.

Answer: (A)

A periapical granuloma is a chronic inflammatory lesion at the tip of a nonvital tooth that develops from granulation tissue and remains continuous with the periodontal ligament at the tooth apex. This continuity with the PDL reflects its origin from pulpal necrosis and infection spreading along the ligament space into the periapical tissues. Because it is a mass of inflammatory granulation tissue rather than a closed cyst or hollow cavity, it is not encapsulated in a separate fibrous capsule and is not a fluid-filled lumen. Radiographically, it typically appears as a radiolucent area around the apex due to bone resorption, not radiopaque. Thus, the defining feature is its ongoing connection with the periodontal ligament at the tooth apex.