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The correct diagnosis of pathological lesions of endodontic origin should allow for differentiation from those arising from other sources. A case of periapical cemental dysplasia (cementoma) is presented, whereby incorrect diagnosis resulted in not only inappropriate treatment, but an endodontic mishap and the superimposition of acute apical periodontitis in a previously disease-free site. This case report highlights the need for appropriate examination, simple special tests and diagnosis prior to management of lesions of questionable aetiology.

Following adequate tissue incision, reflection and retraction to expose the surgical site, the next stages of periradicular surgery consist of osseous access through the cortical bone, if still intact, and subsequent removal of any soft tissue lesion surrounding the apical and/or lateral aspects of the associated root to provide unimpeded access to these sites. The soft tissue lesion may on occasions encapsulate foreign material that may perpetuate the lesion if left in situ. Any excised lesion should be sent for histopathologic examination to confirm the clinical diagnosis and exclude other pathoses.