Unicystic Ameloblastoma Mimicking Apical Periodontitis: A Case Series

Introduction: The purpose of this study was to describe a series of unicystic ameloblastomas (UAs) that presented clinical and radiographic similarities to apical periodontitis in order to call the attention of clinicians to the fact that several different diseases are able to mimic endodontic periapical lesions. Methods: A retrospective clinicopathological analysis of 5 patients who had periapical lesions in the mandible initially diagnosed as apical periodontitis but with a final histologic diagnosis of UAs is presented. Results: Three men and 2 women with a mean age of 26.4 years presented lesions involving the posterior mandible. No patient reported pain, and 3 patients showed pulp vitality of the involved teeth. Radiographically, all lesions presented periapical well-defined radiolucencies, ranging from 2 to 3 cm in diameter, and 3 cases presented root resorption. Endodontic therapy was applied in 2 patients who were referred to our clinics because of a lack of involution of the periapical lesions. All patients were submitted to periapical surgical curettage and histologically diagnosed as UA. After a mean follow-up of 45.6 months, all patients are well without signs of recurrence. Conclusions: UA may involve the periapical area of teeth, mimicking an inflammatory lesion of endodontic origin. The diagnosis of periapical lesions should be determined bated on clinical and radiographic aspects. Recalcitrant lesions should be surgically explored and submitted to histologic evaluation. The early diagnosis of nonendodontic lesions mimicking apical periodontitis such as UA may prevent unnecessary endodontic treatment and wide surgical resections. (J Endod 2013;39:145-148)