clinical research
Misdiagnosis of “J-shaped” or “halo” endodontic lesions influence treatment planning among non-endodontist practitioners
Jorge Vera, DDS, MS 1-2
Carolina Saucedo, DDS 2
Ana Arias, DDS 3
Felipe Restrepo, DDS 4
Paula Villa, DDS 4
Monica Romero, MS 1
Jorge Ochoa, DDS 5
Rubén Rosas, MS 2
https://doi.org/10.71347/yjfd356fd
1Advanced Endodontic Program, University at Buffalo School of Dental Medicine
Department of Endodontics, Buffalo, USA
2 Department of Endodontics, Escuela Nacional de Estudios Superiores UNAM-León, México
3 Department of Conservative and Prosthetic Dentistry School of Dentistry, Complutense University, Madrid, Spain
4 Graduate Endodontics Program, Faculty of Dentistry, University of Antioquia, Medellín, Colombia
5 Department of Endodontics, Universidad Veracruzana, México
Corresponding author:
Rubén Rosas, MS
e-mail: rubenrosasaguilar@hotmail.com
Keywords: Endodontic lesion, Endo-perio lesion, J-shaped lesion, Root fracture
Acknowledgements: The authors deny any conflicts of interest
Abstract
Objective: Radiographic “J-shaped” lesions can be present in teeth without vertical root fractures (VRF). The objective of this study was to assess the recommended treatment plan in this type of case.
Methods: Radiographs and clinical data from fifteen necrotic or endodontically-treated teeth with radiographic/tomographic “J-shaped” or “halo” endodontic lesions were presented during a lecture to 323 evaluators for treatment selection. The selection of treatments (endodontic therapy, periodontal therapy, endo-perio combined treatment or extraction) and the influence of patient/tooth-related factors in treatment decision planning were statistically compared.
Results: In general, participants significantly preferred (p<0.0001) an endo-perio combined treatment (44.7%), or extraction (31%) over endodontic therapy. Only 18% of participants would refer the patient to an endodontist or perform root canal therapy. Patient/tooth-related factors did not influence treatment-planning decisions.
Conclusions: Endodontic lesions with a radiographic “J” or “halo” shape were commonly misdiagnosed as endo-perio lesions and endo-perio combined treatment or extraction was often recommended as the treatment of choice.
Clinical significance: A very high percentage of teeth with “J-shaped” radiographic lesions do not have a vertical root fracture or an endo-perio lesion, so an endo-perio combined treatment or extraction should not be the treatment of choice in these cases.
Introduction
The relationship between the attachment apparatus and the root canal system has been widely documented and classified (Simon et al. 2013, Harrington 1979). In most cases, periradicular pathosis occurs apically and can be easily distinguished from endo-perio or periodontal pathosis.
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