Periapical cyst (PC) and periapical granuloma (PG) are common periapical pathologies encountered in relation to non-vital teeth. It is essential to distinguish these two pathologies, as the treatment differs. Periapical cysts require complete cyst removal, whereas periapical granulomas tend to heal after adequate root canal treatment. The present study aimed to assess the efficacy of ImageJ software in radiographic distinction between periapical granuloma and cysts.

Histopathologically confirmed 500 cases of PC and PG (250 each) were included in the present study. Clinicoradiographic data, including age, gender, site, radiographic appearance, and treatment, were collected, and area and diameter were assessed using ImageJ software. The data were entered into a Microsoft Excel spreadsheet 2021 and analysed using SPSS software version 26. Chi-square and independent t tests were used to analyze the data, and a p-value ≤0.05 was considered statistically significant.

500 cases of PG and PC were included. All the cases were histologically confirmed. It was found that the two entities did not differ in age (p-value: 0.114), gender (p-value: 0.532), and cortication of the radiographic margins (p-value: 0.160). However, using ImageJ software, the mean area (586.62± 26.14 mm ² ) and mean diameter (9.34± 1.67 mm) of periapical cyst were significantly greater than the mean area (175.13± 8.92 mm ² ) and mean diameter (5.14± 1.84 mm) of periapical granuloma (p-value: < 0.001).

Periapical granuloma and cyst do not differ in age, gender and radiographic appearance; however, periapical cysts have significantly larger mean area and diameter as compared to granuloma.