Aims: This article describes the
apical infection in endodontically treated tooth 4.5 that spread to adjacent
tooth 4.4. Case Report: A 52-year-old woman was referred for the presence of
radiolucency extending from tooth 4.5 and mental foramen. Spontaneous
symptoms were present. Tooth 4.5 showed poor-quality endodontics. The vitality
of tooth 4.4 was negative, even though no mechanical trauma had been reported,
nor was caries present. Both teeth were sensitive to percussion. Endodontic
re-treatment of 4.5 and endodontic treatment of 4.4 were performed in a single
visit. A large amount of endodontic sealer squeezed mesially from the root of
tooth 4.5, where a partial horizontal root fracture was hypothesized. 6-,
12-, and 18-month radiographic follow-ups, by both periapical and cone-beam computed tomography (CBCT) analyses, showed incomplete osseous healing. CBCT excluded root fracture on
4.5. Local symptoms were still present. Clinical and radiological conditions
led to extractions, and a cystic lesion was enucleated for histopathologic analyses. Histopathologic diagnosis
was a periapical cyst. The supposed partial horizontal root fracture of
4.5 was actually a large lateral canal. Although the root canal treatments
followed high standards in terms of quality, a persistent chronic infection
developed histologically. The cystic lesion was one consistent reason for the
unsuccessful healing of 4.5.
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