An unusually large asymptomatic periapical lesion that presented as a random finding on a panoramic radiograph

This report presents an asymptomatic case of a large mandibular periapical lesion that was discovered as a random finding on a panoramic radiograph.

A panoramic radiograph was asked for removal of wisdom tooth's roots. The radiograph revealed an unusually large lesion extending from lower premolar to opposite lower canine. Upon clinical examination a discolored lower central incisor and an elevation of the vestibule were visible. The discolored tooth did not respond to thermal and electrical vitality tests and was not tender to percussion. No history of trauma was recorded and all other teeth in the lower anterior area were vital. Surgical excision of the lesion was decided after denial of conservative treatment by the patient. The result was satisfactory and 6 months after the operation new bone was formed at the site of the lesion.

Dentists should be very careful on clinical examination and should not omit any details. Before beginning any treatment a careful and complete clinical and radiographic examination is needed to supply all the required information. Small clinical signs such as a discolored tooth should alert the dentist.