Skip to main content
SpringerLink
Log in
Book cover

Complications in Endodontic Surgery pp 7–17Cite as

Zebra Hunt: Clinical Reasoning and Misdiagnosis

  • Chapter
  • First Online:

Abstract

Diagnosis is the art and science of detecting and distinguishing deviations from health and the cause and nature thereof and should be the foundation for clinical decision making.

Adequate diagnosis is based on sound knowledge and efficient clinical reasoning. Errors during the clinical reasoning process may ultimately lead to misdiagnosis and ensuing complications. This chapter will review misdiagnosis complications in teeth scheduled for endodontic surgery.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. AAE, editor. Glossary of endodontic terms. Chicago: AAE; 2012. Available at: www.aae.org/glossary.

  2. Groves M, O’Rourke P, Alexander H. Clinical reasoning: the relative contribution of identification, interpretation and hypothesis errors to misdiagnosis. Med Teach. 2003;25(6):621–5.

    Article  PubMed  Google Scholar 

  3. Johnson PE, Duran AS, Hassebrock F, Moller J, Prietula M, Feltovich PJ, et al. Expertise and error in diagnostic reasoning. Cognit Sci. 1981;5(3):235–83.

    Article  Google Scholar 

  4. Shulman LB, Driskell TD. Dental implants: a historical perspective. In: Block M, Kent J, Guerra L, editors. Implants in dentistry. Philadelphia: W.B. Saunders; 1997.

    Google Scholar 

  5. Cracking the cracked tooth code: detection and treatment of various longitudinal tooth fractures. Colleagues for excellence, Summer 2008; Chicago: American Association of Endodontics; 2008. Available at: www.aae.org.

  6. Tsesis I, Rosen E, Tamse A, Taschieri S, Kfir A. Diagnosis of vertical root fractures in endodontically treated teeth based on clinical and radiographic indices: a systematic review. J Endod. 2010;36(9):1455–8.

    Article  PubMed  Google Scholar 

  7. Walton RE, Michelich RJ, Smith GN. The histopathogenesis of vertical root fractures. J Endod. 1984;10(2):48–56.

    Article  PubMed  Google Scholar 

  8. Tamse A. Vertical root fractures in endodontically treated teeth: diagnostic signs and clinical management. Endod Topics. 2006;13(1):84–94.

    Article  Google Scholar 

  9. Tamse A, Fuss Z, Lustig J, Kaplavi J. An evaluation of endodontically treated vertically fractured teeth. J Endod. 1999;25(7):506–8.

    Article  PubMed  Google Scholar 

  10. Tamse A. Vertical root fractures of endodontically treated teeth. In: Ingle JI, Bakland LK, Baumgartner JC, editors. Ingle’s endodontics. 6th ed. Hamilton: BC Decker Inc.; 2008. p. 676–89.

    Google Scholar 

  11. Metska ME, Aartman IH, Wesselink PR, Ozok AR. Detection of vertical root fractures in vivo in endodontically treated teeth by cone-beam computed tomography scans. J Endod. 2012;38(10):1344–7.

    Article  PubMed  Google Scholar 

  12. Ferreira RI, Bahrami G, Isidor F, Wenzel A, Haiter-Neto F, Groppo FC. Detection of vertical root fractures by cone-beam computerized tomography in endodontically treated teeth with fiber-resin and titanium posts: an in vitro study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;115(1):e49–57.

    Google Scholar 

  13. Fayad MI, Ashkenaz PJ, Johnson BR. Different representations of vertical root fractures detected by cone-beam volumetric tomography: a case series report. J Endod. 2012;38(10):1435–42.

    Article  PubMed  Google Scholar 

  14. da Silveira PF, Vizzotto MB, Liedke GS, da Silveira HL, Montagner F, da Silveira HE. Detection of vertical root fractures by conventional radiographic examination and cone beam computed tomography – an in vitro analysis. Dent Traumatol. 2013;29(1):41–6.

    Article  PubMed  Google Scholar 

  15. Kambungton J, Janhom A, Prapayasatok S, Pongsiriwet S. Assessment of vertical root fractures using three imaging modalities: cone beam CT, intraoral digital radiography and film. Dentomaxillofac Radiol. 2012;41(2):91–5.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Wang P, He W, Sun H, Lu Q, Ni L. Detection of vertical root fractures in non-endodontically treated molars using cone-beam computed tomography: a report of four representative cases. Dent Traumatol. 2012;28(4):329–33.

    Article  PubMed  Google Scholar 

  17. Edlund M, Nair MK, Nair UP. Detection of vertical root fractures by using cone-beam computed tomography: a clinical study. J Endod. 2011;37(6):768–72.

    Article  PubMed  Google Scholar 

  18. Zou X, Liu D, Yue L, Wu M. The ability of cone-beam computerized tomography to detect vertical root fractures in endodontically treated and nonendodontically treated teeth: a report of 3 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;111(6):797–801.

    Article  PubMed  Google Scholar 

  19. Varshosaz M, Tavakoli MA, Mostafavi M, Baghban AA. Comparison of conventional radiography with cone beam computed tomography for detection of vertical root fractures: an in vitro study. J Oral Sci. 2010;52(4):593–7.

    Article  PubMed  Google Scholar 

  20. Ozer SY. Detection of vertical root fractures by using cone beam computed tomography with variable voxel sizes in an in vitro model. J Endod. 2011;37(1):75–9.

    Article  PubMed  Google Scholar 

  21. Ozer SY. Detection of vertical root fractures of different thicknesses in endodontically enlarged teeth by cone beam computed tomography versus digital radiography. J Endod. 2010;36(7):1245–9.

    Article  PubMed  Google Scholar 

  22. Hassan B, Metska ME, Ozok AR, van der Stelt P, Wesselink PR. Comparison of five cone beam computed tomography systems for the detection of vertical root fractures. J Endod. 2010;36(1):126–9.

    Article  PubMed  Google Scholar 

  23. Hassan B, Metska ME, Ozok AR, van der Stelt P, Wesselink PR. Detection of vertical root fractures in endodontically treated teeth by a cone beam computed tomography scan. J Endod. 2009;35(5):719–22.

    Article  PubMed  Google Scholar 

  24. Bernardes RA, de Moraes IG, Hungaro Duarte MA, Azevedo BC, de Azevedo JR, Bramante CM. Use of cone-beam volumetric tomography in the diagnosis of root fractures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(2):270–7.

    Article  PubMed  Google Scholar 

  25. Dailey B, Mines P, Anderson A, Sweet M, editors. The use of cone beam computer tomography in endodontics: results of a questionnaire. AAE annual session abstract presentation; 2010. Available at: www.aae.org.

  26. de Paula-Silva FW, Wu MK, Leonardo MR, da Silva LA, Wesselink PR. Accuracy of periapical radiography and cone-beam computed tomography scans in diagnosing apical periodontitis using histopathological findings as a gold standard. J Endod. 2009;35(7):1009–12.

    Article  PubMed  Google Scholar 

  27. Youssefzadeh S, Gahleitner A, Dorffner R, Bernhart T, Kainberger FM. Dental vertical root fractures: value of CT in detection. Radiology. 1999;210(2):545–9.

    Article  PubMed  Google Scholar 

  28. AAE, AAOMR, editors. AAE and AAOMR joint position statement – use of cone-beam-computed tomography in endodontics. 2010. Available at: www.aaomr.org/news/52024.

  29. Berrington de Gonzalez A, Mahesh M, Kim KP, Bhargavan M, Lewis R, Mettler F, et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med. 2009;169(22):2071–7.

    Article  PubMed  Google Scholar 

  30. Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol. 2001;176(2):289–96.

    Article  PubMed  Google Scholar 

  31. Brenner DJ, Hall EJ. Computed tomography–an increasing source of radiation exposure. N Engl J Med. 2007;357(22):2277–84.

    Article  PubMed  Google Scholar 

  32. Parker L. Computed tomography scanning in children: radiation risks. Pediatr Hematol Oncol. 2001;18(5):307–8.

    Article  PubMed  Google Scholar 

  33. Pearce MS, Salotti JA, Little MP, McHugh K, Lee C, Kim KP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet. 2012;380(9840):499–505.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Rehani MM, Berry M. Radiation doses in computed tomography. The increasing doses of radiation need to be controlled. BMJ. 2000;320(7235):593–4.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Patel S. New dimensions in endodontic imaging: Part 2. Cone beam computed tomography. Int Endod J. 2009;42(6):463–75.

    Article  PubMed  Google Scholar 

  36. Gondak RO, Rocha AC, Neves Campos JG, Vargas PA, de Almeida OP, Lopes MA, et al. Unicystic ameloblastoma mimicking apical periodontitis: a case series. J Endod. 2013;39(1):145–8.

    Article  PubMed  Google Scholar 

  37. Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and maxillofacial pathology. 3rd ed. St. Louis: Elsevier.

    Google Scholar 

  38. Kuc I, Peters E, Pan J. Comparison of clinical and histologic diagnoses in periapical lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;89(3):333–7.

    Article  PubMed  Google Scholar 

  39. Nikitakis NG, Brooks JK, Melakopoulos I, Younis RH, Scheper MA, Pitts MA, et al. Lateral periodontal cysts arising in periapical sites: a report of two cases. J Endod. 2010;36(10):1707–11.

    Article  PubMed  Google Scholar 

  40. Ortega A, Farina V, Gallardo A, Espinoza I, Acosta S. Nonendodontic periapical lesions: a retrospective study in Chile. Int Endod J. 2007;40(5):386–90.

    Article  PubMed  Google Scholar 

  41. Spatafore CM, Griffin Jr JA, Keyes GG, Wearden S, Skidmore AE. Periapical biopsy report: an analysis of over a 10-year period. J Endod. 1990;16(5):239–41.

    Article  PubMed  Google Scholar 

  42. Anneroth G, Berglund G, Kahnberg KE. Intraosseous salivary gland tissue of the mandible mimicking a periapical lesion. Int J Oral Maxillofac Surg. 1990;19(2):74–5.

    Article  PubMed  Google Scholar 

  43. Sekerci AE, Sisman Y, Etoz M, Bulut DG. Aberrant anatomical variation of maxillary sinus mimicking periapical cyst: a report of Two cases and role of CBCT in diagnosis. Case Rep Dent. 2013;2013:757645.

    PubMed Central  PubMed  Google Scholar 

  44. Shelley AM, Rushton VE, Horner K. Canalis sinuosus mimicking a periapical inflammatory lesion. Br Dent J. 1999;186(8):378–9.

    PubMed  Google Scholar 

  45. Hancock MA, Brown Jr CE, Hartman KS. Orthokeratinized odontogenic cyst presenting as a periapical lesion. J Endod. 1986;12(11):539–41.

    Article  PubMed  Google Scholar 

  46. Bhaskar SN. Oral surgery–oral pathology conference No. 17, Walter Reed Army Medical Center. Periapical lesions–types, incidence, and clinical features. Oral Surg Oral Med Oral Pathol. 1966;21(5):657–71.

    Article  PubMed  Google Scholar 

  47. Lalonde ER, Luebke RG. The frequency and distribution of periapical cysts and granulomas. An evaluation of 800 specimens. Oral Surg Oral Med Oral Pathol. 1968;25(6):861–8.

    Article  PubMed  Google Scholar 

  48. Brannon RB. The odontogenic keratocyst. A clinicopathologic study of 312 cases. Part I. Clinical features. Oral Surg Oral Med Oral Pathol. 1976;42(1):54–72.

    Article  PubMed  Google Scholar 

  49. Stockdale CR, Chandler NP. The nature of the periapical lesion–a review of 1108 cases. J Dent. 1988;16(3):123–9.

    Article  PubMed  Google Scholar 

  50. Stajcic Z, Paljm A. Keratinization of radicular cyst epithelial lining or occurrence of odontogenic keratocyst in the periapical region? Int J Oral Maxillofac Surg. 1987;16(5):593–5.

    Article  PubMed  Google Scholar 

  51. Garlock JA, Pringle GA, Hicks ML. The odontogenic keratocyst: a potential endodontic misdiagnosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;85(4):452–6.

    Article  PubMed  Google Scholar 

  52. Nohl FS, Gulabivala K. Odontogenic keratocyst as periradicular radiolucency in the anterior mandible: two case reports. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;81(1):103–9.

    Article  PubMed  Google Scholar 

  53. Faitaroni LA, Bueno MR, De Carvalhosa AA, Bruehmueller Ale KA, Estrela C. Ameloblastoma suggesting large apical periodontitis. J Endod. 2008;34(2):216–9.

    Article  PubMed  Google Scholar 

  54. Kashyap B, Reddy PS, Desai RS. Plexiform ameloblastoma mimicking a periapical lesion: a diagnostic dilemma. J Conserv Dent. 2012;15(1):84–6.

    Article  PubMed Central  PubMed  Google Scholar 

  55. Cunha EM, Fernandes AV, Versiani MA, Loyola AM. Unicystic ameloblastoma: a possible pitfall in periapical diagnosis. Int Endod J. 2005;38(5):334–40.

    Article  PubMed  Google Scholar 

  56. Curran AE, Miller EJ, Murrah VA. Adenomatoid odontogenic tumor presenting as periapical disease. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;84(5):557–60.

    Article  PubMed  Google Scholar 

  57. Philipsen HP, Srisuwan T, Reichart PA. Adenomatoid odontogenic tumor mimicking a periapical (radicular) cyst: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94(2):246–8.

    Article  PubMed  Google Scholar 

  58. De Lange J, Van den Akker HP. Clinical and radiological features of central giant-cell lesions of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;99(4):464–70.

    Article  PubMed  Google Scholar 

  59. Dahlkemper P, Wolcott JF, Pringle GA, Hicks ML. Periapical central giant cell granuloma: a potential endodontic misdiagnosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;90(6):739–45.

    Article  PubMed  Google Scholar 

  60. Glickman GN. Central giant cell granuloma associated with a non-vital tooth: a case report. Int Endod J. 1988;21(3):224–30.

    Article  PubMed  Google Scholar 

  61. Lombardi T, Bischof M, Nedir R, Vergain D, Galgano C, Samson J, et al. Periapical central giant cell granuloma misdiagnosed as odontogenic cyst. Int Endod J. 2006;39(6):510–5.

    Article  PubMed  Google Scholar 

  62. Selden HS. Central giant cell granuloma: a troublesome lesion. J Endod. 2000;26(6):371–3.

    Article  PubMed  Google Scholar 

  63. Galgano C, Samson J, Kuffer R, Lombardi T. Focal cemento-osseous dysplasia involving a mandibular lateral incisor. Int Endod J. 2003;36(12):907–11.

    Article  PubMed  Google Scholar 

  64. Drazic R, Minic AJ. Focal cemento-osseous dysplasia in the maxilla mimicking periapical granuloma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;88(1):87–9.

    Article  PubMed  Google Scholar 

  65. Rodrigues CD, Estrela C. Traumatic bone cyst suggestive of large apical periodontitis. J Endod. 2008;34(4):484–9.

    Article  PubMed  Google Scholar 

  66. Abbott PV. Traumatic bone cyst: case report. Endod Dent Traumatol. 1992;8(4):170–5.

    Article  PubMed  Google Scholar 

  67. Martins MD, Taghloubi SA, Bussadori SK, Fernandes KP, Palo RM, Martins MA. Intraosseous schwannoma mimicking a periapical lesion on the adjacent tooth: case report. Int Endod J. 2007;40(1):72–8.

    Article  PubMed  Google Scholar 

  68. Buric N, Jovanovic G, Pesic Z, Krasic D, Radovanovic Z, Mihailovic D, et al. Mandible schwannoma (neurilemmoma) presenting as periapical lesion. Dentomaxillofac Radiol. 2009;38(3):178–81.

    Article  PubMed  Google Scholar 

  69. Rodrigues CD, Villar-Neto MJ, Sobral AP, Da Silveira MM, Silva LB, Estrela C. Lymphangioma mimicking apical periodontitis. J Endod. 2011;37(1):91–6.

    Article  PubMed  Google Scholar 

  70. Hutchison IL, Hopper C, Coonar HS. Neoplasia masquerading as periapical infection. Br Dent J. 1990;168(7):288–94.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Oral Pathology and Oral Medicine, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, 69978, Israel

    Marilena Vered DMD

  2. Department of Endodontology, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, 69978, Israel

    Aviad Tamse DMD, Igor Tsesis DMD & Eyal Rosen DMD

Authors
  1. Marilena Vered DMD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aviad Tamse DMD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Igor Tsesis DMD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eyal Rosen DMD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marilena Vered DMD .

Editor information

Editors and Affiliations

  1. Dept. of Endodontology, Maurice and Gabriela Goldschleger, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel

    Igor Tsesis

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Vered, M., Tamse, A., Tsesis, I., Rosen, E. (2014). Zebra Hunt: Clinical Reasoning and Misdiagnosis. In: Tsesis, I. (eds) Complications in Endodontic Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54218-3_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-54218-3_2

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-54217-6

  • Online ISBN: 978-3-642-54218-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation