Authors' response.

Abstract

We thank Dr Doğramacı and Dr Rossi-Fedele for their interest in our article, which reports an undiagnosed and neglected odontogenic keratocyst before orthodontic treatment.1Leandro Santos R.S. Ramos-Perez F.M.M. Silva G.K. Rocha A.C. Prado J.D. Perez D.E. Odontogenic keratocyst: the role of the orthodontist in the diagnosis of initial lesions.Am J Orthod Dentofacial Orthop. 2017; 152: 553-556Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar The term initial in the title refers to size of the lesion before orthodontic treatment. After 12 months, undoubtedly, the lesion was not initial. Although most endodontic lesions are periapical, lateral endodontic lesions are also common. The presence of a midradicular radiolucency between 2 teeth cannot be considered a criterion to exclude an inflammatory endodontic lesion.2de Andrade M. Silva A.P. de Moraes Ramos-Perez F.M. Silva-Sousa Y.T. da Cruz Perez D.E. Lateral periodontal cyst: report of case and review of the literature.Oral Maxillofac Surg. 2012; 16: 83-87Crossref PubMed Scopus (20) Google Scholar In the patient in our article, the endodontic treatment was performed by another clinician, and the patient sought us to provide a diagnostic opinion afterward. For this reason, further information about the endodontic treatment, such as periapical radiography and pulp vitality status, could not be registered. Clinically, the presence of pulp vitality excludes the possibility of a chronic periapical lesion. However, about 70% of the cases of periapical nonendodontic lesions are associated with teeth with pulp necrosis (or with negative pulp vitality tests) or are endodontically treated,3Ortega A. Fariña V. Gallardo A. Espinoza I. Acosta S. Nonendodontic periapical lesions: a retrospective study in Chile.Int Endod J. 2007; 40: 386-390Crossref PubMed Scopus (32) Google Scholar an additional factor of diagnostic challenge. Therefore, the diagnosis is not as simple as it appears at first glance. Detailed clinical examination, including pulpal vitality testing, is essential and needed irrespective of the case. If endodontic treatment is recommended, the patient should be followed until total regression of the periapical radiolucency. Otherwise, the lesion should be excised and sent for histopathologic analysis. With respect to radiographs reports, we partially disagree. In this case, the panoramic radiograph was not performed by the responsible clinician, but in an oral radiology clinic. Undoubtedly, an experienced and judicious oral radiologist can identify and diagnose a bone lesion.4de Moraes Ramos-Perez F.M. de Pádua J.M. Silva-Sousa Y.T. de Almeida O.P. da Cruz Perez D.E. Primary xanthoma of the mandible.Dentomaxillofac Radiol. 2011; 40: 393-396Crossref PubMed Scopus (16) Google Scholar For a proper radiographic report, the clinical information must be provided by the responsible practitioner. However, the responsible clinician, in any case, should always review the radiographic examination, not only to identify whether some image was inadvertently missing, but mainly to correlate the clinical-radiographic findings that would result in the most effective and accurate diagnosis and treatment. In summary, the patient should always be carefully examined. The diagnosis and treatment of bone lesions require a multidisciplinary team, which will result in a successful approach and consequently a better quality of life for the patient. Odontogenic keratocyst: the pitfalls of uncoordinated multidisciplinary careAmerican Journal of Orthodontics and Dentofacial OrthopedicsVol. 153Issue 2PreviewWe read with interest the case report involving an odontogenic keratocyst.1 We disagree with the use of the word “initial” in the title, since the lesion remained undiagnosed for more than a year, even after orthodontic treatment had commenced in its presence. Full-Text PDF