Clinical and Radiographic Features of Diagnosis of Chronic Apical Periodontitis

This article presents a comprehensive analysis of the clinical and radiological parameters that determine the diagnostic features of various morphological forms of chronic apical periodontitis. The relevance of the study is associated with the need to improve the accuracy of visualizing periapical alterations and optimize the choice of diagnostic methods, given the significant variability of clinical manifestations. The aim of the research was to compare the diagnostic value of clinical indicators and radiological imaging data, as well as to perform a quantitative assessment of bone destruction volume in fibrous, granulomatous, and granulomatous forms of chronic apical periodontitis. Another objective was to determine the most appropriate radiological modality for each form of the disease. A comparative evaluation of the three forms of chronic apical periodontitis was conducted using a combination of traditional and advanced imaging techniques, including periapical radiography, orthopantomography, and cone-beam computed tomography (CBCT). The findings indicate that the fibrous form is characterized by minimal inflammatory response and relative preservation of periapical tissues; the granulomatous form is associated with pronounced clinical symptoms and progressive bone destruction; and the granulomatous form presents as a well-defined lesion with distinct margins. The study demonstrated a clear advantage of CBCT over other imaging modalities. CBCT provides highly accurate three-dimensional visualization of the pathological focus, allowing detailed assessment of its volume, internal structure, degree of cortical destruction, and spatial relationships with adjacent anatomical structures. This establishes CBCT as the most informative and pathogenetically justified method for radiological diagnosis of chronic apical periodontitis. The results underline the importance of an integrated diagnostic approach that combines clinical evaluation with multiple imaging methods. Such a strategy enables more precise differentiation of the disease forms and contributes to the selection of the most effective treatment plan.