Ameloblastoma Suggesting Large Apical Periodontitis

doi:10.1016/j.joen.2007.11.010

Journal of Endodontics

Volume 34, Issue 2, February 2008, Pages 216-219

https://doi.org/10.1016/j.joen.2007.11.010 Get rights and content

Abstract

This case report describes the endodontic treatment of a large apical periodontitis with well-defined margins adjacent to teeth #22–24. After the initial endodontic treatment, continued expansion of the mandible cortical bone was observed, indicating a need to surgically enucleate the lesion and submit it for histopathologic examination. The microscopic examination indicated a diagnosis of ameloblastoma. Ameloblastoma is a benign epithelial neoplasm of odontogenic origin, and depending on the stage of development, it can mimic a periapical lesion and therefore should be considered in establishing an endodontic differential diagnosis. The definitive diagnosis for some periapical lesions can only be made by a histopathologic examination.

Section snippets

Case Report

A 54-year-old male patient was referred to a general practitioner for routine dental treatment. The patient’s dental history indicated there was no history of chronic orofacial pain or trauma. The patient complained of a low intensity discomfort to pressure and palpation in periapical area of teeth #23–24. The radiographic analysis revealed a well-defined radiolucent area approximately 2.0 cm in diameter in the periapical area of teeth #22–24, with a lateral shift in the position of the teeth (

Discussion

The most prevalent cause of periapical lesions is associated with microorganisms from infected root canal systems (3). However, differential diagnoses of periapical lesions should consider lesions of nonendodontic origin, including odontogenic cysts, periapical cemento-osseous dysplasias, giant cell lesions, ameloblastomas, and lymphomas (6, 7, 8). These lesions require distinct treatment regimens, exhibit different prognoses, and should be considered in establishing the differential diagnosis

Conclusions

Periapical lesions generally present etiologic factors correlated with microorganisms from necrotic pulp. However, diseases from nonendodontic origins associated with tooth apex should be considered in differential diagnosis as ameloblastoma.

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Cited by (31)

Non-Hodgkin's Lymphoma of the Anterior Maxilla Mimicking a Chronic Apical Abscess
2020, Journal of Endodontics
Non-Hodgkin lymphomas (NHLs) are malignant neoplasms of the lymphatic system, typically occurring in the fifth through seventh decades of life. Tumors develop from abnormal lymphocyte proliferation and accumulation. Although a majority of NHLs occur in nodal regions, 40% of cases appear in extranodal sites involving the stomach, spleen, Waldeyer's ring, central nervous system, lung, skin, and bone. Extranodal NHL presents a diagnostic challenge because it may mimic endodontic disease when occurring in intraosseous and soft tissue sites. This case report presents misdiagnosis of a diffuse large B-cell lymphoma (DLBCL) of the anterior maxilla in a 72-year-old man with a history of Waldenstrom's macroglobulinemia, where the lesion was thought to be associated with a necrotic pulp and a chronic apical abscess on tooth #7. Clinical findings of a facial sinus tract, a nonresponsive pulp, large periapical radiolucency, and history of trauma were in support of this diagnosis for tooth #7. On encountering vital pulpal tissues during cavity access of tooth #7, a cone-beam computed tomography scan and lesion biopsy were obtained. Through immunohistochemistry and histologic analysis, a diagnosis of DLBCL was made. During evaluation of lesions with suspected endodontic etiology, the clinician should consider all factors of the patient's health history, hereditary risk, and comprehensive clinical testing to attain a differential diagnosis. A nonodontogenic etiology of disease should always be considered unless ruled out otherwise. Atypical presentation or testing may prompt the need for biopsy and interspecialty assessment.
Intraoral mass in the posterior maxillary vestibule
2015, Journal of the American Dental Association
Citation Excerpt :
Our patient’s differential diagnosis list included an inflammatory oral mucosal disease; however, she did not have factors causing local trauma, such as dental prosthesis or parafunctional habits.12,13 Although periapical diseases of nonendodontic origin may resemble malignant neoplasms,14 our review of the patient’s case revealed a lack of the following important signs of chronic apical periodontitis: clinical radiographic evidence of bone involvement or vestibular cortical expansion, and negative pulp vitality testing.14-16 Extranodal non-Hodgkin lymphoma may occur in the jaws and is associated with nonspecific clinical signals or symptoms such as local discomfort, related cervical lymphadenopathy, swelling, pain, ulcer, and tooth mobility.14
Inflammatory Myofibroblastic Tumor Mimicking Apical Periodontitis
2015, Journal of Endodontics
Inflammatory myofibroblastic tumors (IMTs) are rare. IMTs of the head and neck occur in all age groups, from neonates to old age, with the highest incidence occurring in childhood and early adulthood. An IMT has been defined as a histologically distinctive lesion of uncertain behavior. This article describes an unusual case of IMT mimicking apical periodontitis in the mandible of a 42-year-old man. At first presentation, the patient showed spontaneous pain and percussion pain at teeth #28 to 30, which continued after initial endodontic treatment. Panoramic radiography revealed a radiolucent lesion at the site. Cone-beam computed tomographic imaging showed osteolytic lesions, suggesting an aggressive neoplasm requiring incisional biopsy. Histopathological examination indicated an IMT. The lesion was removed en bloc under general anesthesia, and the patient manifested no clinical evidence of recurrence for 24 months. Lesions of nonendodontic origin should be included in the differential diagnosis of apical periodontitis. Every available diagnostic tool should be used to confirm the diagnosis. Cone-beam computed tomographic imaging is very helpful for differential diagnosis in IMTs mimicking apical periodontitis.
10-year follow-up of calcifying odontogenic cyst in the periapical region of vital maxillary central incisor
2014, Journal of Endodontics
Radiographic images may lead to misinterpretations of lesions of endodontic and nonendodontic origin. This report describes a case of a 10-year follow-up of a calcifying odontogenic cyst (COC) in the periapical region of a vital maxillary central incisor in a 9-year-old boy.
The patient revealed a history of a swelling in the periapical area of tooth #9. The patient denied any dental trauma or history of pain. Clinical examination revealed no mobility, but there was discrete discomfort when horizontal pressure was applied. Pulp vitality was present in all maxillary anterior teeth. Radiographs revealed an oval radiolucent lesion in the periapical region of maxillary central incisor. The therapeutic option was enucleation of the periapical lesion and histologic examination of the specimen. Microscopic findings suggested the diagnosis of a COC.
At a follow-up visit 10 years after surgery, panoramic and periapical radiographs showed new bone formation; the patient did not have any pain, and pulp vitality was maintained in all teeth in this area.
A COC should be part of the differential diagnosis of other jaw lesions, such as apical periodontitis. The definitive diagnosis of a COC can only be made after microscopic evaluation of the specimen. The follow-up is a helpful reference because it confirms the survival of pulp tissue and no recurrence of the COC.
8-year follow-up of central giant cell lesion mimicking apical periodontitis
2014, Journal of Endodontics
Citation Excerpt :
Clinical and radiographic characteristics, medical and dental history, pulp vitality testing, and aspiration results are important components of a thorough endodontic diagnosis (2). However, when signs and symptoms are suggestive of nonendodontic lesions, biopsies and subsequent microscopic examinations are mandatory (1–7). CGCLs are non-neoplastic lesions of unknown etiology and variable dimensions and rate of development (1, 3, 10–13).
Lesions of nonendodontic origin may mimic apical periodontitis. Central giant cell lesions (CGCLs) are aggressive or nonaggressive benign idiopathic intraosseous lesions of the jaw. This report describes a case of a CGCL in the periapical region of teeth #21–#26 of a 17-year-old female who sought orthodontic care because of a change in the position of tooth #23.
Clinical examination revealed mild facial asymmetry caused by increased volume in the mental region and cortical bone expansion but no cortical disruption. A panoramic radiograph showed a well-defined radiolucent osteolytic lesion involving teeth #21–#26. The cortical bone was not affected, and there was no root resorption. Incisional biopsy was performed, and the diagnosis was a CGCL. The lesion was enucleated surgically. CGCLs should be included in the differential diagnosis of jaw lesions that mimic apical periodontitis.
The patient subsequently underwent orthodontic treatment successfully.
The 8-year clinical and radiographic follow-up confirmed lesion remission, no recurrence, and pulp vitality of all teeth.
Nonendodontic lesions misdiagnosed as apical periodontitis lesions: Series of case reports and review of literature
2014, Journal of Endodontics
This study aimed to analyze cases referred from a reference service in oral pathology that were initially misdiagnosed as periapical lesions of endodontic origin and to perform a review of the literature regarding lesions located in the apical area of teeth with a nonendodontic source.
A survey was made of clinical cases derived from the service of oral pathology from 2002 to 2012. The pertinent literature was also reviewed using ScienceDirect and PubMed databases. The lesions were grouped into benign lesions mimicking endodontic periapical lesions (BLMEPLs), malignant lesions mimicking endodontic periapical lesions (MLMEPLs), and Stafne bone cavities. The clinical presentations were divided into lesions with swelling without pain, lesions with swelling and pain, and lesions without swelling but presenting with pain.
The results showed that 66% (37/56) of cases represented benign lesions, 29% (16/56) malignant lesions, and 5% (3/56) Stafne bone cavities. The most commonly reported BLMEPLs were ameloblastomas (21%) followed by nasopalatine duct cysts (13.5%). The most frequently cited MLMEPLs were metastatic injuries (31.5%) followed by carcinomas (25%). The main clinical presentation of BLMEPLs was pain, whereas that of MLMEPLs was swelling associated with pain; Stafne bone cavities displayed particular clinical findings.
Clinical and radiologic aspects as well as the analysis of the patients' medical history, pulp vitality tests, and aspiration are essential tools for developing a correct diagnosis of periapical lesions of endodontic origin. However, if the instruments mentioned earlier indicate a lesion of nonendodontic origin, a biopsy and subsequent histopathological analysis are mandatory.

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Case report/clinical techniqueAmeloblastoma Suggesting Large Apical Periodontitis

Abstract

Section snippets

Case Report

Discussion

Conclusions

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

J Oral Maxillofac Surg

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

J Am Dent Assoc

Oral Oncol

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

J Endod

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Case report/clinical technique
Ameloblastoma Suggesting Large Apical Periodontitis