Diagnostic considerations while utilizing intraoral periapical radiographs for diagnosing radix entomolaris

Abstract

Radiopacity seen in periapical area in periapical radiographs can be sometimes be tricky to interpret and diagnose. Occurrence of radix entomolaris is rare in mandibular first molar and mandibular second premolar. This rare entity may probably be misdiagnosed if the practitioner does not acquire periapical radiographs using appropriate techniques. A male patient aged 28 years presented with chief complaint of decayed teeth in right lower back region of mouth. On intraoral examination, 46 was observed to be decayed and non tender on vertical percussion. An intraoral periapical radiograph (IOPA) was advised for the same. Well defined radiopacities were observed in between roots of 46 and 45. A tentative diagnosis of idiopathic osteosclerosis was made. However, since the radiopaque structure resembled that of a tooth root, another IOPA at a different horizontal angulation was taken. To our surprise, 46 exhibited an additional supernumerary root. Also, the presence of an additional lingual root in relation to 45 was noted.The present case report demonstrates the impact on interpretation/diagnosis an angulation difference can make while taking a periapical radiograph through example of case which exhibited the rare occurrence of radix entomolaris and concurrent additional root in second mandibular premolar.