Differential diagnosis of apical periodontitis and nasopalatine duct cyst: case report

Constantino Fernandes Neto, Murilo Priori Alcalde, Clovis Monteiro Bramante, Marco Antonio Hungaro Duarte, Rodrigo Ricci Vivan.

The presence of periapical bone alteration in the anterior maxilla, particularly between maxillary incisors, can be mistaken for apical periodontitis (AP) or nasopalatine duct cyst (NPDC) of which accurate differential diagnosis should be established to define the best treatment for endodontically untreated maxillary anterior teeth. The proper use of clinical sources of investigation, especially pulp sensibility tests, is of paramount importance, since it is tested negative in cases of apical periodontitis, differently from cases of nasopalatine duct cysts. The patient, a 48-year-old women with swelling in the palate and in the anterior gutter area, feeling acute pain surrounding maxillary central incisors, sought the Endodontic Clinic where she was meticulously examined and submitted to radiographic examinations. Clinical examination revealed absence of pulp vitality, and radiographs showed a radiolucent area appearing symmetrically on both sides of the midline, which could have been an endodontic lesion or a NPDC. During endodontic treatment, a communication between the root canal and the periapical lesion was observed, suggesting it might be an endodontic problem. Root canal treatment was performed and after eight months of follow-up it was possible to observe the periapical lesion was under process of repair. This case evinces the importance of an accurate differential diagnosis of AP and NPDC to lead to a suitable treatment and favor periapical tissue repair.

Keywords: Oral diagnosis. Endodontics. Periapical periodontitis. Nonodontogenic cysts.

How to cite: Fernandes Neto C, Alcalde MP, Bramante CM, Duarte MAH, Vivan RR. Differential diagnosis of apical periodontitis and nasopalatine duct cyst: case report. Dental Press Endod. 2017 Jan-Apr;7(1):20-5. DOI: http://dx.doi.org/10.14436/2358-2545.7.1.020-025.oar

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