Calcifying odontogenic cyst (COC) can be misdiagnosed as a lesion of endodontic origin
when it is in close proximity to the periradicular tissue, and pulp sensibility tests
are indispensable for differential diagnosis. However, when the adjacent teeth are
necrotic or already endodontically treated, diagnosis becomes challenging.
In this case report, a maxillary canine with an inadequate root canal treatment was
considered as the source of an endodontic infection. Eight months after the retreatment,
the patient sought treatment for a buccal intraoral swelling and a deep periodontal
pocket and was referred for cone-beam computed tomography with a provisional diagnosis
of a vertical root fracture. The tomography revealed an extensive lesion buccally
to the roots of the canine and the adjacent vital lateral incisor. An unusual extended
external resorption of the root of the vital lateral incisor was also evident. This
finding shifted the diagnostic thinking toward a lesion of nonendodontic origin. The
lesion was surgically enucleated, and the histopathologic examination confirmed the
diagnosis of a COC.
Clinicians always must bear in mind the chance of a nonendodontic lesion masquerading
as a lesion of endodontic origin. Cone-beam computed tomography should be considered
in cases of doubt or in lesions refractory to endodontic treatment, as it can provide
information on the clinicopathologic features of the lesion.
CBCT (Cone-beam computed tomography), COC (Calcifying odontogenic cyst), VRF (Vertical root fracture)
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Pathogenesis of apical periodontitis and the causes of endodontic failures.
Crit Rev Oral Biol Med. 2004; 15: 348-381
Prevalence of apical periodontitis and conventional nonsurgical root canal treatment in general adult population: an updated systematic review and meta-analysis of cross-sectional studies published between 2012 and 2020.
J Endod. 2020; 46: 1371-1386
10-year follow-up of calcifying odontogenic cyst in the periapical region of vital maxillary central incisor.
J Endod. 2014; 40: 1695-1697
A diagnostic dilemma: endodontic lesion or odontogenic keratocyst? A case presentation.
Int Endod J. 2008; 41: 800-806
Frequency and distribution of radiolucent jaw lesions: a retrospective analysis of 9,723 cases.
J Endod. 2012; 38: 729-732
Nonendodontic lesions misdiagnosed as apical periodontitis lesions: series of case reports and review of the literature.
J Endod. 2014; 40: 16-27
Periapical lesions are not always a sequelae of pulpal necrosis: a retrospective study of 1521 biopsies.
Int Endod J. 2015; 48: 68-73
Unicystic ameloblastoma mimicking apical periodontitis: a case series.
J Endod. 2013; 39: 145-148
The calcifying odontogenic cyst: a possible analogue of the cutaneous calcifying epithelioma of Malherbe—an analysis of fifteen cases.
Oral Surg Oral Med Oral Pathol. 1962; 15: 1235-1243
- El-Naggar A.K. Chan J.K.C. Grandis J.R. Takata T. Slootweg P.J. WHO Classification of Head and Neck Tumours. 4th ed. IARC Press,
Calcifying odontogenic cyst, dentinogenic ghost cell tumor and ghost cell odontogenic carcinoma: a systematic review.
J Oral Pathol Med. 2018; 47: 721-730
Cysts of the Oral and Maxillofacial Regions.
4th ed. Blackwell Munksgaard,
Radiographic characteristics of the calcifying odontogenic cyst.
Int J Oral Maxillofac Surg. 1988; 17: 29-32
The central (intraossous) calcifying odontogenic cyst: an analysis of 215 cases.
J Oral Maxillofac Surg. 1991; 49: 330-339
Persistent apical periodontitis associated with a calcifying odontogenic cyst.
Int Endod J. 2009; 42: 539-545
- Rajendran R. Sivapathasundharam B. Shafer’s Textbook of Oral Pathology. 7th ed. Elsevier,
AAE and AAOMR joint position statement: use of cone beam computed tomography in endodontics—2015/2016 update.
European Society of Endodontology position statement: use of cone beam computed tomography in endodontics.
Int Endod J. 2019; 52: 1675-1678
Clinical application of cone beam computed tomography in endodontics: a comprehensive review.
Quintessence Int. 2015; 46: 657-668
Cone beam computed tomography in endodontics: a review of the literature.
Int Endod J. 2019; 52: 1138-1152
The impact of cone beam computed tomography on the choice of endodontic diagnosis.
Int Endod J. 2015; 48: 564-572
Assessment of cone-beam computed tomographic referral reasons and the impact of cone-beam computed tomographic evaluation on decision treatment planning procedure in endodontics.
J Endod. 2020; 46: 1414-1419
Cone-beam computed tomography for detecting vertical root fractures in endodontically treated teeth: a systematic review.
J Endod. 2016; 42: 177-185
Role of cone-beam computed tomography in diagnosis of vertical root fractures: a systematic review and meta-analysis.
J Endod. 2016; 42: 12-24
Different representations of vertical root fractures detected by cone-beam volumetric tomography: a case series report.
J Endod. 2012; 38: 1435-1442
Cone-beam computed tomography versus periapical radiograph for diagnosing external root resorption: a systematic review and meta-analysis.
Angle Orthod. 2017; 87: 328-337
Diagnostic accuracy of small volume cone beam computed tomography and intraoral periapical radiography for the detection of simulated external inflammatory root resorption.
Int Endod J. 2011; 44: 136-147
Cystic ameloblastoma-an endodontic differential diagnostic problem.
J Endod. 1987; 13: 358-361
Ameloblastomas: a regional Latin-American multicentric study.
Oral Dis. 2007; 13: 303-307
Maxillary odontogenic keratocyst: a common and serious clinical misdiagnosis.
JADA. 2003; 134: 877-883
International collaborative study of ghost cell odontogenic tumours: calcifying cystic odontogenic tumour, dentinogenic ghost cell tumour and ghost cell odontogenic carcinoma.
J Oral Pathol Med. 2008; 37: 302-308
Dr. Stefopoulos is in private practice limited to endodontics, Patras, Greece.
Dr. Melakopoulos is an oral and maxillofacial surgeon, Department of Oral and Maxillofacial Surgery, Hygeia Hospital, Athens, Greece.
Dr. Tosios is an associate professor, Department of Oral Pathology, Dental School of Athens, National and Kapodistrian University of Athens, Athens, Greece.
Dr. Kerezoudis is a professor, Department of Endodontics, Dental School of Athens, National and Kapodistrian University of Athens, Athens, Greece
Published online: November 21, 2022
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Disclosures. None of the authors reported any disclosures.
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