{"id":7313,"date":"2026-07-30T06:00:00","date_gmt":"2026-07-30T06:00:00","guid":{"rendered":"https:\/\/www.belodonte.es\/?p=7313"},"modified":"2026-05-22T09:09:34","modified_gmt":"2026-05-22T09:09:34","slug":"granuloma-periapical-que-es-simptomes-quan-requereix-cirurgia","status":"publish","type":"post","link":"https:\/\/www.belodonte.es\/ca\/granuloma-periapical-que-es-simptomes-quan-requereix-cirurgia\/","title":{"rendered":"Granuloma periapical: qu\u00e8 \u00e9s, s\u00edmptomes i quan requereix cirurgia"},"content":{"rendered":"\n

El granuloma periapical<\/strong> \u00e9s la lesi\u00f3 inflamat\u00f2ria cr\u00f2nica m\u00e9s freq\u00fcent dels teixits que envolten l’extrem de l’arrel dental (l’\u00e0pex). Es forma com a resposta de l’organisme enfront d’una infecci\u00f3 bacteriana procedent de l’interior de la dent, habitualment a conseq\u00fc\u00e8ncia d’una necrosi pulpar no tractada o d’un tractament de conductes que no ha aconseguit eliminar completament la c\u00e0rrega bacteriana. Encara que en molts casos cursa de manera silenciosa durant mesos o anys, la seva pres\u00e8ncia implica una destrucci\u00f3 \u00f2ssia activa que requereix diagn\u00f2stic i tractament espec\u00edfic. Des de Cl\u00ednica Belodonte, experts en Cirurgia Oral i Maxil\u00b7lofacial a Barcelona<\/a><\/strong>, parlem sobre aix\u00f2.<\/p>\n\n\n\n

Com es forma un granuloma periapical?<\/h2>\n\n\n\n

Quan la polpa dental (el teixit tou de l’interior de la dent que cont\u00e9 nervis i vasos sanguinis) es necrosa per una c\u00e0ries profunda, un traumatisme o una fractura dent\u00e0ria, els bacteris que colonitzen el conducte radicular arriben al teixit ossi que envolta l’\u00e0pex de l’arrel i desencadenen una resposta inflamat\u00f2ria cr\u00f2nica.<\/p>\n\n\n\n

L’organisme intenta contenir aquesta infecci\u00f3 formant una c\u00e0psula de teixit de granulaci\u00f3 (teixit inflamatori cr\u00f2nic compost per macr\u00f2fags, limf\u00f2cits, c\u00e8l\u00b7lules plasm\u00e0tiques i fibroblasts) al voltant del focus infecci\u00f3s. Aquesta c\u00e0psula \u00e9s el granuloma periapical. Encara que la seva funci\u00f3 inicial \u00e9s protectora (limita l’extensi\u00f3 de la infecci\u00f3), la seva pres\u00e8ncia implica una reabsorci\u00f3 \u00f2ssia progressiva en la zona periapical que, amb el temps, pot afectar les arrels de les dents adjacents i comprometre la viabilitat d’estructures ve\u00efnes com el si maxil\u00b7lar.<\/p>\n\n\n\n

Quins s\u00edmptomes produeix el granuloma periapical?<\/h2>\n\n\n\n

Una de les caracter\u00edstiques m\u00e9s rellevants del granuloma periapical des del punt de vista cl\u00ednic \u00e9s precisament el seu silenci. En la majoria dels casos no produeix dolor espontani ni s\u00edmptomes locals evidents, la qual cosa explica que molts pacients desconeguin la seva exist\u00e8ncia fins que es detecta de manera incidental en una radiografia de control. Quan el granuloma es reactiva per una baixada de les defenses de l’organisme, un traumatisme local o un canvi en la virul\u00e8ncia bacteriana, pot aguditzar-se i manifestar-se com un absc\u00e9s periapical agut, amb dolor intens i pulsatiu, tumefacci\u00f3 i febre.<\/p>\n\n\n\n

Altres s\u00edmptomes possibles, encara que menys freq\u00fcents, inclouen una lleugera sensibilitat a la percussi\u00f3 de la dent afectada, la pres\u00e8ncia d’una f\u00edstula (un trajecte que drena el contingut del granuloma cap a la geniva o la pell) i, en granulomes de gran grand\u00e0ria, una lleu expansi\u00f3 de la cortical \u00f2ssia perceptible a la palpaci\u00f3.<\/p>\n\n\n\n

Com es diagnostica i qu\u00e8 ho diferencia d’un quist periapical?<\/h2>\n\n\n\n

El diagn\u00f2stic del granuloma periapical \u00e9s radiol\u00f2gic en primera inst\u00e0ncia: apareix com una zona radiol\u00facida (m\u00e9s fosca) ben delimitada al voltant de l’\u00e0pex de l’arrel en la radiografia periapical o en l’ortopantomografia. No obstant aix\u00f2, la imatge radiol\u00f2gica no permet diferenciar amb certesa el granuloma periapical d’un quist radicular (una altra lesi\u00f3 periapical freq\u00fcent amb la qual comparteix aspecte radiol\u00f2gic), ja que totes dues lesions poden tenir una grand\u00e0ria i una morfologia similars. L’\u00fanica manera d’establir el diagn\u00f2stic definitiu i diferencial entre totes dues entitats \u00e9s l’estudi anatomopatol\u00f2gic de la lesi\u00f3 despr\u00e9s de la seva extirpaci\u00f3 quir\u00fargica.<\/p>\n\n\n\n

El CBCT (tomografia computada de feix c\u00f2nic) aporta informaci\u00f3 tridimensional valuosa sobre la grand\u00e0ria exacta de la lesi\u00f3, la seva relaci\u00f3 amb les arrels de les dents ve\u00efnes i la seva proximitat a estructures anat\u00f2miques com el si maxil\u00b7lar o el nervi dentari inferior, la qual cosa \u00e9s determinant per a la planificaci\u00f3 quir\u00fargica.<\/p>\n\n\n\n

Quan pot resoldre’s amb tractament de conductes i quan requereix cirurgia?<\/h2>\n\n\n\n

El tractament de primera elecci\u00f3 del granuloma periapical \u00e9s el tractament endod\u00f2ntic (tractament de conductes), que elimina el focus infecci\u00f3s intraradicular mitjan\u00e7ant la instrumentaci\u00f3, desinfecci\u00f3 i segellament herm\u00e8tic del sistema de conductes. Quan el tractament endod\u00f2ntic es realitza correctament, el granuloma t\u00e9 capacitat de resoldre’s de manera espont\u00e0nia en un per\u00edode de sis a vint-i-quatre mesos, sent substitu\u00eft progressivament per os de nova formaci\u00f3.<\/p>\n\n\n\n

El seguiment radiol\u00f2gic peri\u00f2dic (habitualment als sis, dotze i vint-i-quatre mesos) permet verificar la resoluci\u00f3 de la lesi\u00f3. La cirurgia est\u00e0 indicada quan el tractament endod\u00f2ntic primari o retratat no aconsegueix resoldre la lesi\u00f3, quan existeixen factors anat\u00f2mics que impedeixen l’acc\u00e9s endod\u00f2ntic adequat a l’\u00e0pex (conductes calcificats, curvatures radiculars extremes, instrumentaci\u00f3 pr\u00e8via deficient no corregible), quan la lesi\u00f3 \u00e9s de gran grand\u00e0ria o quan la sospita cl\u00ednica apunta cap a un quist en lloc d’un granuloma.<\/p>\n\n\n\n

En qu\u00e8 consisteix la apicectomia i quan s’indica?<\/h2>\n\n\n\n

La apicectomia (tamb\u00e9 anomenada cirurgia periapical o resecci\u00f3 apical) \u00e9s el procediment quir\u00fargic d’elecci\u00f3 per al tractament del granuloma periapical quan l’abordatge endod\u00f2ntic no \u00e9s suficient.<\/p>\n\n\n\n

Consisteix en la resecci\u00f3 de l’extrem de l’arrel de la dent (l’\u00e0pex) juntament amb l’extirpaci\u00f3 completa del teixit patol\u00f2gic periapical, seguida del segellament retr\u00f2grad de l’extrem del conducte amb un material biocompatible (habitualment MTA, sigles en angl\u00e8s d’agregat tri\u00f2xid mineral) per a evitar la reinfecci\u00f3 des de l’interior de la dent.<\/p>\n\n\n\n

El procediment es realitza sota anest\u00e8sia local de manera ambulat\u00f2ria, amb una durada aproximada d’entre 45 i 90 minuts segons la complexitat del cas. En Cl\u00ednica Belodonte la apicectomia es planifica sobre CBCT i es realitza amb magnificaci\u00f3 (lupa o microscopi quir\u00fargic) per a maximitzar la precisi\u00f3 i minimitzar el trauma ossi.<\/p>\n\n\n\n

Quin \u00e9s el pron\u00f2stic despr\u00e9s del tractament quir\u00fargic?<\/h2>\n\n\n\n

El pron\u00f2stic de la apicectomia \u00e9s favorable quan la selecci\u00f3 del cas \u00e9s adequada i la t\u00e8cnica quir\u00fargica s’executa amb rigor. Les taxes d’\u00e8xit publicades en la literatura cient\u00edfica oscil\u00b7len entre el 74% i el 94% a llarg termini, depenent de factors com la grand\u00e0ria de la lesi\u00f3 preoperat\u00f2ria, la qualitat del segellament endod\u00f2ntic previ, el tipus de material d’obturaci\u00f3 retr\u00f2grada utilitzat i l’experi\u00e8ncia del cirurgi\u00e0.<\/p>\n\n\n\n

El seguiment radiol\u00f2gic postquir\u00fargic \u00e9s imprescindible per a confirmar la regeneraci\u00f3 \u00f2ssia progressiva de la cavitat i detectar preco\u00e7ment qualsevol signe de frac\u00e0s. En els casos en qu\u00e8 la apicectomia no aconsegueix resoldre la lesi\u00f3, l’extracci\u00f3 de la dent amb posterior rehabilitaci\u00f3 en implantologia \u00e9s l’alternativa terap\u00e8utica de rescat.<\/p>\n\n\n\n

Si t’han dit que tens una lesi\u00f3 en la punta de l’arrel d’una dent, no el deixis passar. Com m\u00e9s aviat millor s’avalu\u00ef, majors s\u00f3n les possibilitats de conservar la dent amb un tractament m\u00ednimament invasiu. Contacta amb nosaltres.<\/a><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

El granuloma periapical \u00e9s la lesi\u00f3 inflamat\u00f2ria cr\u00f2nica m\u00e9s freq\u00fcent dels teixits que envolten l’extrem de l’arrel dental (l’\u00e0pex). Es forma com a resposta de l’organisme enfront d’una infecci\u00f3 bacteriana procedent de l’interior de la dent, habitualment a conseq\u00fc\u00e8ncia d’una […]<\/p>\n","protected":false},"author":3,"featured_media":7312,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[32],"tags":[],"class_list":["post-7313","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-cirugia-oral"],"yoast_head":"\nGranuloma periapical: qu\u00e8 \u00e9s, s\u00edmptomes i quan requereix cirurgia - Cl\u00ednica Belodonte<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.belodonte.es\/granuloma-periapical-que-es-sintomas-cuando-requiere-cirugia\/\" \/>\n<meta property=\"og:locale\" content=\"ca_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Granuloma periapical: qu\u00e8 \u00e9s, s\u00edmptomes i quan requereix cirurgia - Cl\u00ednica Belodonte\" \/>\n<meta property=\"og:description\" content=\"El granuloma periapical \u00e9s la lesi\u00f3 inflamat\u00f2ria cr\u00f2nica m\u00e9s freq\u00fcent dels teixits que envolten l’extrem de l’arrel dental (l’\u00e0pex). 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