From: Christian Hohmann
To: ROOTS
Sent: Thursday, May 22, 2008 9:00 PM
Subject: [roots] Teeth 36, help with diagnosis

please have a look at the attached x-ray. It is a patient who comes to our office for check-up.
he has no pain or discomfort at this teeth.

I think there is one broken instruments in each mesial canal. all the roots seem to have a LEO.

But what do you think is the opaque structure in the distal root. condensing osteitis or any calcification???
Thank you very much for any help - Chris, Berlin



Chris,

What a messy case!  The original treatment obviously wend kinda rough ;-))).

That lesion at the distal root apex does not look like condensing osteitis to me.  The rediolucent halo and mixed
rediodense/lucent nature of the lesion suggests an odontoma or similar.  There's no displacement of the teeth by the
lesion nor is there destruction of the roots.  Another angle would help pinpoint it's location.

It would be nice to have historical radiographs, but I know that's not always a luxury.  It would be a tragedy if the
original treatment was initiated for the sake of the lesion only in the absence of symptoms and pulpal testing.

Surgical biopsy of the lesion would risk devitalization of the second molar, but if an apical surgery were attempted on
the first molar, I'd take out the lesion as well.

Good Luck - Scott