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Case Reports
. 2019 Mar 21:41:1-5.
doi: 10.1016/j.amsu.2019.03.003. eCollection 2019 May.

Apical periodontitis associated with a calculus-like deposit: A case report of a rare fan-shaped manifestation

Kênia M Toubes  1 , Stéphanie Q Tonelli  1 , Bruno J de Oliveira  2 , Graziele Duarte  1 , Eduardo Nunes  1 , Frank F Silveira  1   2
Affiliations
Case Reports

Apical periodontitis associated with a calculus-like deposit: A case report of a rare fan-shaped manifestation

Kênia M Toubes et al. Ann Med Surg (Lond). .

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.

Keywords: Apicoectomy; Biofilms; Cone-beam computed tomography; Dental radiography; Periapical periodontitis.

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Figures

Fig. 1
Fig. 1
(A–D) Maxillary left central incisor showed no significant periodontal probing depth; (E) Fragments of cotton ball and cone of absorbent paper removed from canal; (F–G) Radiographic exam of final canal filled; (H) Surgical access.
Fig. 2
Fig. 2
(A) Preoperative radiograph image showing fan-shaped radiopaque image associate with radiolucent area on the apex of the maxillary left central incisor extending apically to the lateral incisor, associated with radiopaque areas. (B) CBCT image showing hypodense, heterogeneous, irregular edges.
Fig. 3
Fig. 3
Histopathological analysis image which can be observed fibrous connective tissue presenting calcified areas.
See this image and copyright information in PMC

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