1st year resident Albert Einstein Medical Center Philadelphia, Pennsylvania, United States
The differential diagnosis of apical lesions can be challenging in endodontic practice. The decision to initiate root canal therapy (RCT) should never be solely based on the radiographic appearance of the case. The patient's clinical history and pulp testing must be essential to avoid diagnostic errors. Transient apical breakdown (TAB) is a rare and poorly understood apical condition typically associated with a history of trauma. However, it can also be present during orthodontic treatment. Clinically, patients will have delayed or absent pulp response to sensibility tests. Radiographically, a periapical radiolucency and/or a widening of the PDL spaces appear spontaneously after an injury or because of a persistent parafunctional habit. We present two clinical cases of TAB in which a child developed tooth discoloration and apical pathosis due to a parafunctional habit of biting on Lego blocks. The second patient, a young adult, experienced pain after two months of wearing a do-it-yourself clear aligner and developed a sizeable apical lesion related to the mandibular incisors. No RCT was performed even though the radiographic appearance of the cases suggested the presence of active pulpal origin pathoses. Eight and 12-months follow-ups showed marked radiographic and sensibility improvement on the affected teeth.
