A patient presented with pain in the lower anterior area.  A fairly good-looking and recent root canal (approx. over 2 months old) had been performed on tooth #4.2.  Patient’s pain however had been progressively getting worse since the completion of treatment.  The pain was not occlusion-related and analgesics had not been helping either.  Upon diagnostic testing, all other lower incisors responded normally to cold testing despite showing some evidence of periapical changes.  None of these teeth were previously restored either, except for a class V restoration on tooth #3.2.

The pattern of PA lesion associated with tooth #4.2 (mixed radiopaque-radiolucent lesion), lack of previous restorations and bone pattern changes around vital teeth made me suspicious of periapical cemental dysplasia (PCD).  To confirm my suspicion and to manage patient’s pain (possibly not related to PDC), apical surgery was performed for tooth #4.2.  The biopsy confirmed the final diagnosis of benign fibro-osseous lesion consistent with PCD.

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Six-month recall radiograph confirms the complete healing of the surgical site and the patient has remained asymptomatic.  I cannot explain the biological process involved in patient’s appearance, persistence and resolution of pain but here are some facts about PCD:

• etiology is unknown
• mandibular incisors are most commonly involved teeth
• multiple lesions may be present at different stages: osteolytic (radiolucent), intermediate (mixed) and mature (radiopaque)
• lesions are always asymptomatic
• involved teeth are vital

Therefore, vitality testing is the key to diagnosis and radiographic follow-up and frequent observations are the most appropriate treatments for cases like this.

endodontic diagnosis non-odontogenic lesion periapical cemental dysplasia