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Persistent Periradicular Lesion Associated With Concurrent Root Fracture and Odontogenic Keratocyst: A Case Report
Mehdi Vatanpour1, Fatemeh Rezaei1
1Department of Endodontics, Faculty of Dentistry, Tehran Medical Sciences Islamic Azad University Tehran Iran.
Clinical Case Reports
|November 12, 2025
Summary
A persistent periradicular lesion in a root canal-treated tooth was diagnosed as an odontogenic keratocyst (OKC) and root fracture. This rare combination highlights the need for thorough investigation of persistent endodontic lesions.
Area of Science:
- Dentistry
- Oral Pathology
- Endodontics
Background:
- Persistent periradicular lesions after root canal treatment pose diagnostic challenges.
- Differential diagnoses include endodontic failure, root fracture, and non-endodontic pathologies.
Purpose of the Study:
- To report a rare case of a persistent periradicular lesion in a root canal-treated maxillary incisor.
- To highlight the diagnostic challenges and management of combined root fracture and odontogenic keratocyst (OKC).
Main Methods:
- Cone-beam computed tomography (CBCT) for radiographic assessment.
- Exploratory surgery with methylene blue staining to confirm root fracture.
- Histopathological examination of the lesion for definitive diagnosis.
Main Results:
- Nonsurgical root canal retreatment failed to resolve the chronic apical abscess.
- CBCT suggested a root fracture.
- Surgery confirmed a root fracture, and histopathology revealed an odontogenic keratocyst (OKC).
Conclusions:
- The co-occurrence of root fracture and OKC is rare and can mimic endodontic disease.
- Accurate diagnosis requires correlating clinical, radiographic, and histopathological findings.
- Biopsy is crucial for definitive diagnosis and treatment planning of persistent periradicular lesions.
