Toubes KM, Tonelli SQ, Oliveira BJD, Duarte G, Nunes E, Silveira FF. Apical periodontitis associated with a calculus-like deposit: A case report of a rare fan-shaped manifestation.
Ann Med Surg (Lond) 2019;
41:1-5. [PMID:
30962929 PMCID:
PMC6434093 DOI:
10.1016/j.amsu.2019.03.003]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 11/05/2022] Open
Abstract
Introduction
Bacterial biofilms can be calcified. Granulomas or cystic lesions are the most commonly found entities in endodontics. Surprisingly, this case report presents a rare radiopaque image, in a fan shape, of a calculus-like deposit in the periapical region of the maxillary left central incisor.
Case presentation
A 34-year-old male, with a history of trauma, presented with apical periodontitis associated with an uncommon image, similar to a calculus-like deposit adhered to the apical region of the maxillary left central incisor. Nonsurgical endodontic intervention was performed, followed by apicoectomy and histopathological analysis of the collected material. The results of the biopsy were not compatible with a cyst or granuloma but showed fibrous connective tissue with calcified areas.
Discussion
Correct diagnosis in endodontics is possible with a well-conducted anamnesis, complementary imaging exams and, in some cases, histopathological analysis. The periapical calculus-like deposit, associated with a periapical radiolucent lesion, was a result of the body's fight for healing, producing unusual radiopacity.
Conclusion
The presence of the calculus-like deposit in a fan shape at the root surface represented dystrophic calcification as a manifestation of the attempt to heal. In the present case, apicoectomy and tissue biopsy for histological evaluation were fundamental for the correct diagnosis.
Root canal is critical area for biofilm development.
Extraradicular biofilm on the surface of the root may cause persistent periapical lesions.
Uncommon radiopaque image association with endodontic periapical lesions was related.
Persistent periapical lesions associate with extraradicular biofilm represents a challenge for Endodontic treatment.
Only surgical resection was capable to repair the injury.
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