Periapical radiolucency in endodontically treated teeth is typically managed via conventional retreatment or apical surgery. However, non-inflammatory odontogenic tumors, such as an adenomatoid odontogenic tumor (AOT), can mimic common periapical pathologies, potentially leading to diagnostic errors. This case report describes the multidisciplinary management of an AOT in a 24-year-old male, highlighting the significant diagnostic challenge where a benign tumor mimicked persistent endodontic failure. The patient presented with a 7 × 8 mm hard labial swelling and throbbing pain in the maxillary anterior region. Despite the tooth (12) having undergone previous root canal therapy, clinical and radiographic findings revealed a periapical radiolucency with associated buccal cortical resorption. Unique to this case, the surgical intervention was performed without suspending active orthodontic forces, requiring a regenerative strategy to ensure stability under mechanical loading. The intervention involved non-surgical retrieval of previous filling material, surgical enucleation of the tumor, and advanced regenerative techniques, including osseografts, platelet-rich fibrin, and guided tissue regeneration without root-end resection. This case demonstrates that the synergy of bioactive materials and conservative surgical techniques can achieve predictable bone regeneration and long-term tooth preservation, even in the demanding environment of active orthodontic loading.
Shanmugavelu et al. (Mon,) studied this question.