Diagnosis of periapical granuloma in a tooth with non-endodontic lesion characteristics

Abstract

Endodontic diagnosis can be challenging when radiographic and clinical aspects do not correlate. Female patient, 50 years old, sought care at the Dental Specialties Center of Senador Canedo, Goiás, with the chief complaint of discomfort and swelling in the buccal mucosa of teeth #32, #31 and #41. The periapical radiograph revealed a radiolucent area involving the roots of the teeth #32, #31, #41 and #42. The vertical and horizontal percussion tests were negative, and the cold pulp sensitivity test was positive in all teeth. As tooth #31 had a change in the color of the crown, a cavity test was performed to certify the pulp vitality, whose response was also positive. Thus, the initial diagnostic hypothesis was a non-endodontic lesion. After anesthesia, aspiration puncture, excisional biopsy and referral to the Centro Goiano de Doenças da Boca (FO-UFG, Goiânia/Go) were performed. The anatomopathological diagnosis was periapical granuloma, in disagreement with the tests previously performed. After a conclusive diagnosis, tooth #31 went through the stages of endodontic access, canal preparation with Universal Protaper system (Denstply-Maillefer), irrigation with 2.5% NaOCl and 17% EDTA solution, intracanal medication with Ca(OH)2 PA with saline solution and sealing with Sealapex endodontic cement (Sybron Endo) after 21 days. At the follow-up three year later, radiographic aspects show complete periapical repair. The aim of this study is to describe a case report in which clinical signs and symptoms were not compatible with the anatomopathological findings, discussing the importance of exhausting all diagnostic resources for proper decision-making.

Key Words: Diagnosis, periapical granuloma, root canal preparation