Lucent area 304 root apex

RE: Lucent area 304 root apex

Anthony Todd — Fri, 18 May 2018 09:20:48 GMT

[quote user="Evelyn Barbour-Hill"]I think it could be arising from endodontic disease.[/quote]

I have almost exactly the same after a root filled incisor which did get infected, drained via the root canal and now radio-lucent but asymptomatic. [Dire proposals by dentists for years]

Tap the canine with the handle of something; if no reaction, PMI for evermore unless the tap test is positive.

RE: Lucent area 304 root apex

Evelyn Barbour-Hill — Thu, 17 May 2018 23:18:57 GMT

[quote user="Kate Richardson"]I can only come up with infection (unlikely- correct me if you disagree)[/quote]

I think it could be arising from endodontic disease.

RE: Lucent area 304 root apex

Evelyn Barbour-Hill — Thu, 17 May 2018 01:51:36 GMT

[quote user="Sarah Keir"]

What would be the risk of fracture if did extract one or both? (rhetorical question)

[/quote]

Not being funny, but it would depend very much on your extraction skill.

RE: Lucent area 304 root apex

Sarah Keir — Wed, 16 May 2018 21:07:35 GMT

What would be the risk of fracture if did extract one or both? (rhetorical question)

RE: Lucent area 304 root apex

Rob Davis — Wed, 16 May 2018 20:01:07 GMT

[quote user="Kate Richardson"]

Totally get what you are saying but to turn it round on you, what are your differentials and this treatment options? It’s not painful, it’s not swollen, lymph node is normal. I can only come up with infection (unlikely- correct me if you disagree) or neoplasia (would you thinking a benign slowly progressive type as it doesn’t look like any neoplastic jaw lesion I’ve ever seen) in which case could it be treatable?

[/quote]

Fair point...

Differentials: neoplasia, benign cyst of some description - could be potentially curable with surgery (and potentially less invasive surgery than for neoplasia), infection (may be treatable medically/surgically).

Regardless of aetiology pathological fracture will be a risk if it progresses.

However, if clinically quiescent then leaving it alone is fine as long as the owners appreciate that it may progress and that it may be more difficult to treat in the future if it does progress. It is equally possible that it will stay like that forever more and you'll never get to find out what it is....

RE: Lucent area 304 root apex

Kate Richardson — Wed, 16 May 2018 19:27:22 GMT

RE: Lucent area 304 root apex

Rob Davis — Wed, 16 May 2018 19:03:52 GMT

No right answer, and not going to know without exploring/biopsying. I would explain pros and cons of leaving vs exploring to the owners and let them decide. Do let us know if you ever do find out what it is!

Would it be possible to post the pictures as separate jpegs? I find them slightly hard to view all together like this.

RE: Lucent area 304 root apex

Evelyn Barbour-Hill — Wed, 16 May 2018 18:29:31 GMT

[quote user="Kate Richardson"]

I'm just reluctant to interfere given lack of progression.

[/quote]

Fair enough.... for myself, I think I'd like to know what it is I'm not treating...

RE: Lucent area 304 root apex

Kate Richardson — Wed, 16 May 2018 17:04:19 GMT

I'm just reluctant to interfere given lack of progression.

RE: Lucent area 304 root apex

Miriam Lodewyks — Wed, 16 May 2018 16:46:54 GMT

Mmmmm, interesting. I'd go with wot he said...

RE: Lucent area 304 root apex

Kate Richardson — Wed, 16 May 2018 15:19:04 GMT

Evelyn Barbour-Hill couldn't add the clinical info to the photo post so was typing as you replied! No symptoms associated with it

RE: Lucent area 304 root apex

Kate Richardson — Wed, 16 May 2018 15:17:26 GMT

What do you think? Series of xrays over 4 months. Tooth stable. I know there is resorptive change on both 304 and particularly 404 (we are monitoring them closely), but cat initially presented with severe dental disease (I can post the full mouth xrays if needed) and needed majority of teeth (or bits of) extracted- had to defer procedure for a month as had quite severe bronchopneumonia when hewas first referred to me.

This lesion doesn't appear to be progressing, cat was on doxycycline for 8-10 weeks to clear mycoplasma infection and also had 3 weeks of clindamycin, neither of which led to any change. Is now in on inhaled fluticasone and salbutamol for the underlying bronchitis

Interested to see what others think. Cat is currently well

RE: Lucent area 304 root apex

Evelyn Barbour-Hill — Wed, 16 May 2018 15:10:06 GMT

Any symptoms with it?

Both those canines show resorption, of course, and there is some sort of defect in the crown of the 304 (may be of no significance). The radiolucent area could represent neoplasia or chronic infection.

If there's an obvious thinning area, go in through that, otherwise extract the tooth to get in, see what's inside! Unless it's obviously purulent, scoop out some material for histopathology.