Multiple periradicular radiolucencies mimicking endodontic lesions in renal osteodystrophy of the mandible: a case report

Abstract

A 47-year-old woman was referred by her general dentist to the postgraduate endodontic clinic for assessment and root canal treatment of multiple teeth with associated periapical radiolucencies. The patient's medical history included chronic renal failure. All mandibular teeth with periapical radiolucencies except tooth 37 had positive responses to pulp sensibility testing. A diagnosis of pulpal necrosis and associated periapical periodontitis was made on tooth 37, and root canal treatment was carried out. To determine the possible relationship between the patient's renal disease and the multiple periapical radiolucencies, an additional physician consultation and laboratory tests were requested. Secondary hyperparathyroidism was confirmed with the laboratory report showing an elevated level of parathyroid hormone and a normal serum calcium level. Renal osteodystrophy of the mandible caused by secondary hyperparathyroidism was the probable aetiology of the multiple mandibular periapical radiolucencies, and no root canal treatment was required. Key learning points Renal osteodystrophy of the mandible caused by secondary hyperparathyroidism can present as multiple periapical radiolucencies but is a rare finding. Diverse orofacial manifestations such as loss of lamina dura, widening of periodontal ligament and demineralization of bone can be observed in renal osteodystrophy. Thorough clinical and radiographic assessment along with the review of patient's medical history and haematological analysis is essential for the diagnosis of renal osteodystrophy.

PRICE 2020 guidelines for reporting case reports in Endodontics: explanation and elaboration

“…From Jalali & Kim (2016) – ‘After informed consent was obtained, the root canal treatment for tooth 37 was performed under a surgical microscope’.…”

“…From Jalali & Kim (2016) – ‘A 47‐year‐old Asian woman was referred to the postgraduate endodontic clinic by her general dentist for assessment and root canal treatment of multiple teeth with associated periapical radiolucencies’.…”

“…From Jalali & Kim (2016) – ‘The patient’s medical history included chronic renal failure. The patient’s medication included sevelamer carbonate (RenvelaR) for the treatment of hyperphosphatemia caused by her renal disease’.…”

Manifestations of systemic diseases and conditions that affect the periodontal attachment apparatus: Case definitions and diagnostic considerations

“…Giant cell granulomas manifest as expanding epulis‐like gingival swellings and cause expanding osteolytic lesions in the deep periodontal tissue, which can, on occasion, expand toward the marginal periodontal tissue. In hyperparathyroidism, single or multiple osteolytic lesions (brown tumors) in the jaw have been reported and can mimic bone loss due to periodontitis . In addition, loss of the lamina dura and widening of the periodontal ligament may be common findings .…”

Manifestations of systemic diseases and conditions that affect the periodontal attachment apparatus: Case definitions and diagnostic considerations

“…Giant cell granulomas manifest as expanding epulis-like gingival swellings and cause expanding osteolytic lesions in the deep periodontal tissue, which can, on occasion, expand toward the marginal periodontal tissue. In hyperparathyroidism, single or multiple osteolytic lesions (brown tumors) in the jaw have been reported and can mimic bone loss due to periodontitis 88. In addition, loss of the lamina dura and widening of the periodontal ligament may be common findings 89.…”