case_images: PMC9192198_01
case_images: Initial OPG of the patient depicting a unilocular radiolucency encompassing the apices of the mandibular second premolar and first molar.
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case_images: PMC9192198_01_CRID2022-7323268.001.jpg
case_images: fig1
case_images: An initial orthopantomography (OPG) was obtained which revealed a uniloculated, radiolucent lesion engulfing the apices of the mandibular right second premolar and an endodontically treated first molar, extending to the superior border of the inferior alveolar nerve canal with an irregular shape dissimilar to what is routinely observed in periapical cysts or granulomas associated with endodontically treated teeth (Figure 1).
case_images: Initial CBCT obtained from the patient further revealing the extents of the lesion.
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case_images: fig2
case_images: The lesion measured 23.4 x 14.2 x 6.6 mm at its peaks (Figure 2).
case_images: Microscopic findings of fibroconnective tissue containing few crushed bone particles severely infiltrated by acute inflammatory cells and some foamy macrophages (H&E staining, magnification level 10 x 40).
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case_images: PMC9192198_01_CRID2022-7323268.003.jpg
case_images: fig3
case_images: Microscopic evaluations revealed fragments of fibroconnective tissue including few crushed bone particles severely infiltrated by acute inflammatory cells and some foamy macrophages (Figure 3).
case_images: The suppurative exudate focally surrounding colonies of filamentous bacteria as round basophilic masses with radial configuration resembling "sulfur granules" (H&E staining, magnification level 10 x 40).
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case_images: fig4
case_images: The suppurative exudate focally surrounds colonies of filamentous bacteria as round basophilic masses with radial configuration resembling "sulfur granules" (Figure 4).
case_images: Mandibular second molar was endodontically retreated and referred back to us for further evaluation.
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case_images: PMC9192198_01_CRID2022-7323268.005.jpg
case_images: fig5
case_images: However, the endodontist endodontically retreated the tooth and the patient was referred back to us for the subsequent periapical surgery (Figure 5).