Endodontic Misdiagnosis? A Clinician’s Perspective on Uncertainty

For endodontists, it is easy to assume that any radiolucency associated with pain is of pulpal or inflammatory origin, especially if the tooth has a significant restorative history. However, numerous disease entities of variable clinical significance can be identified in the periapical region, and differentiating the typical endodontic presentation from that of a potentially more life threatening or insidious etiology is of critical importance to ensure ideal management and outcome. This review, based on clinical cases, will highlight a variety of diagnostic roadblocks including the limitations of pulp testing and radiographic interpretation of periapical images and cone beam computerized tomography. Advanced endodontic diagnosis with systematic method for the development of a differential diagnosis of periapical radiolucencies will be the main focus of this discussion.