How was that missed? (Chronic Apical Periodontitis / Rarefying Osteitis) 1


This months how was that missed is a case of chronic apical periodontitis or rarefying osteitis.  The first radiograph is 2 years prior to the second one.

Initial interpretation: No initial interpretation as this radiograph was made for an implant in the maxillary canine region and nothing else was evaluated.  🙁

Final Interpretation: Rarefying osteitis at the apex of the maxillary left second premolar with external resorption (most likely due to the presence of a periapical granuloma at some time).  Upon reviewing the older radiographs, the rarefying osteitis was evident on radiographs from 2 years prior.    

Lesson learned:  It is important to remember to evaluate the entire radiograph and not focus on only the area or tooth where treatment is planned.  This case is a good reminder that every aspect of every radiograph must be thoroughly evaluated.

If you have any questions about this case, please let me know. Thanks and enjoy!

Next week: Pantomograph Positioning Errors Part 2

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One thought on “How was that missed? (Chronic Apical Periodontitis / Rarefying Osteitis)

  • dina

    is tht cause roluscent at max left second premolar from heavy contact?is it possible of tht?bcse if it was from previous granuloma it means tht tooth nonvtal n shuold be treated wth endodontic,but we ddnt see any endo treatmen…thks for discussion