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Objective: Periapical granulomas, chronic periapical osteitis produced particularly by the bacterial continuous agression from the endodontic space, can develop accordingly, or they can transform in epithelial or cystic granulomas, their diagnosis being more difficult to determine at these stages. This study aimed to emphasize a few aspects that can conduce to an easier diagnosis establishment. Materials and method: 78 patients with periapical chronic periodontitis have been evaluated in order to assess their evolution to epithelial or cystic granulomas. These cases were monitorised during the endodontic treatment and, were necessary, endodontic surgery was performed and samples for the histopathologic exam were drawn, in order to make an accurate diagnose. Results: From the 78 cases of teeth with chronic periapical periodontitis, 18 required surgical approach: 4 curettages, 5 apicectomies, 9 extractions, from which 7 were labeled as cystic granulomas, after the microscope examination. Conclusions: Untill the comming out of an accurate diagnosis method for these lesions, the practitioner must consider all possible data from the anamnesis to the clinic and radiographic exam, the only relyable method to establish a correct diagnosis being the histopathologic exam. [ABSTRACT FROM AUTHOR]