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July 2005 – LEO Mimics Perio Pathology

Many clinicians take a quick look at a radiograph, see the characteristic radiolucent halo that ususlly is associated with a periodontally involved tooth and then proceed to extraction.

It is important to pulp test all teeth with periradicular lucencies. Many of these teeth are actually non-vital and unusual lateral anatomy that forms lateral POEs ( Portals of Exit). The lesions caused by these lateral PEOs often occur not at the end of the root, but at the side – mimicking a perio lesion.

Fig. 1 Fig. 2 Fig. 3 Fig. 4

This mandibular first premolar presented with a large, deep multisurface amalgam. The mesial marginal enamel had broken off and there was recurrent decay under the amalgam. Pulp tests showed no response to thermal tests.  A diagnosis of pulpal necrosis was made and the lateral nature of the LEO was noted. I anticipated a large lateral canal(s) that was causing the characteristic lateral lesion.

The initial working length file showded a relatively straight canal. The canal system was cleaned with a combination of  hand files and ProTapers. The lateral anatomy initially appeared visible during the cone fit/sealer film. The downpack film showed multiple portals of exit on the distal aspect of the tooth with two large lateral canals. It appears that most of the pathology in this case was associated with the lateral canals rather than the most apical “main” canal. 



Fig. 5