Dr. Farzad Danesh, certified endodontist, invites you to review the case study below.
| Not All Lateral Radiolucencies Are Vertical Root Fractures! |
Case study:
A 77-year-old Caucasian woman was referred for tooth 4.6 endodontic consultation. Medical history was not contributory.
Intra-orally, there was a sinus tract at the distal aspect of the tooth close to the crest. A 10-mm pocket was found at the distal-buccal aspect of the tooth. Deep pockets were also noted in other areas of mouth. The radiography showed previous root canal treatment and a rarefying osteitis at distal which had extended to the crestal bone. The sinus tract has been traced by the referring dentist (Fig 1). The CT scan demonstrated a big lateral radiolucency (orange arrows) (Figs 2 and 3).
Tooth 4.6 diagnosis was previous RCT and chronic apical abscess. A crack, a vertical root fracture(VRF), or a combined endodontic and periodontal disease was also suspected.
Re-treatment was started in late Jan 2022. Note the big radiolucency at distal (Fig 4). The canals were disinfected and CH was placed. No crack was noted under surgical microscope.
At a 3-month follow up the sinus tract healed. No probable pocket was detected at distal-buccal.
In May 2022 (6 months after initiation of treatment), the canals were filled. The radiography revealed the lesion was healing at distal (Fig 5).
At a 10-month follow up in NOV 2022, the radiography demonstrated complete healing of the lateral radiolucency (Fig 6).
Conclusion: Radiography alone is misleading. Combining clinical and radiological findings is essential for a firm diagnosis.
Reference: Eric Rivera: Longitudinal tooth fractures: findings that contribute to complex endodontic diagnoses. Endodontic Topics 2007