Immune periapical granuloma with Mott cells: Endodontic significance and need for identification

Periapical granulomas (PGs) respond well to endodontic treatment. In case of refractory response to the treatment apicectomy and finally, extraction is the treatment of choice. Herein, we present a case of endodontically failed PG with an excessive amount of Mott cells (MCs). MCs are plasma cells with spherical aggregates in their cytoplasm. The extensive accumulation of MCs in a periapical lesion is hitherto underreported and might elucidate the cause of refractory treatment outcomes of certain periapical lesions. The lesion was diagnosed with immune PG with multiple MCs. To the best of our literature search, there have been only two similar reports till date. Additional case reports and long-term follow-up are necessary to understand the nature and significance of such lesions. This article aspires to further the awareness regarding such unique presentation to aid appropriate diagnosis and also highlights the importance of subjecting apicectomy specimen to histopathological examination.