Medication-Related Osteonecrosis of the Jaw (MRONJ) Mistaken for Acute Apical Abscess.

The objective of this case study is to report on the diagnosis and treatment of medication-related osteonecrosis of the jaw (MRONJ), which was originally misdiagnosed and mistreated as endodontic disease. A patient was referred for worsening odontalgia despite root canal therapy on tooth No. 19 and a course of oral antibiotics. Examination demonstrated slight buccal swelling and tenderness in the left masseter and a 7-mm diameter area of exposed bone on the mandibular left lingual torus. Further history-taking revealed prior bisphosphonate therapy for metastatic breast cancer. MRONJ was identified as the likely diagnosis, and the patient was appropriately referred to oral and maxillofacial surgery where the diagnosis was confirmed and surgical debridement performed. The case study demonstrates how the symptomatology and presentation of MRONJ can resemble endodontic disease and that timely and appropriate treatment requires eliciting an in-depth medical history, reaching a complete pulpal and periapical diagnosis, and remaining attentive to the presence of exposed bone on examination.

Cementoblastoma Mimicking Pathology of Endodontic Origin: A Case Report.

Interdisciplinary care in the management of complex pathology is critical to ensure patients receive predictable, evidence-based treatment. The authors report the unique case of a healthy 38-year-old female patient who presented to a private endodontics practice with a radiopaque lesion associated with the root of tooth No. 20. The patient experienced mild and occasional palpation tenderness associated with the tooth. Extraoral examination and intraoral soft tissues presented without any abnormalities. Intraoral radiographs revealed a radiopacity overlying the apex of tooth No. 20. A cone-beam computed tomography scan of the region revealed a well-delineated bulbous radiopaque lesion attached to the lingual aspect of the apical third of the root of tooth No. 20. The lesion could not be distinguished from the root outline and presented with a radiolucent halo along its periphery. The differential diagnosis at the time consisted of cementoblastoma, condensing osteitis, hypercementosis, and periapical cemento-osseous dysplasia. The patient was referred to an oral and maxillofacial surgeon for evaluation and treatment. Tooth No. 20 was subsequently treated with an excisional biopsy and concurrent extraction of the tooth. Histologic examination of the lesion supported the diagnosis of cementoblastoma.