Preservation Of Pulp Vitality Of Vital Teeth With Periapical Lesions

Periapical lesions have endodontic and nonendodontic origins, and chronic apical periodontitis is the clinically most encountered radiolucency in the jaws. There is little literature on the expansion of periapical lesions in vital teeth from neighboring endodontically involved teeth with chronic apical periodontitis. A 37-year-old female patient complained of discomfort in the lower left posterior teeth for 1 month. Clinical examination revealed dens evaginatus in tooth #35 with a fractured cusp and pulp exposure. Tooth #36 was intact and responded normally to the cold and electric pulp tests. Periapical radiograph and CBCT revealed an immature root apex of tooth #35 and a large lesion encompassing the roots of teeth #36 and #35. A diagnosis of symptomatic apical periodontitis concerning tooth #35 was established, and root canal treatment was accomplished regularly. In the follow-ups, tooth #36 maintained pulp vitality. After 61 months, periapical radiograph revealed completed bone healing and normal periapical tissue of teeth #36 and #35. Periapical lesions of vital teeth may occur due to expansion from the neighboring endodontically involved teeth with chronic apical periodontitis. Nonsurgical and/or surgical treatment led to the resolution of the periapical lesion and maintained pulp vitality of the neighboring teeth. For periapical lesions, a careful diagnostic process, including meticulous clinical and radiographic examinations, particularly pulp sensitivity and vitality tests, enables the establishment of an accurate differential diagnosis and, together with appropriate treatment, can preserve tooth vitality and prevent misdiagnosis and endodontic intervention.