Wegener’s granulomatosis (WG) is a condition with immune-mediated pathogenesis that can present oral manifestations. This report describes the case of a patient diagnosed with WG 14 years previously, who was affected by persistent pain of non-odontogenic origin after successful endodontic treatment. A 39-year-old woman with WG was diagnosed with pulp necrosis and apical periodontitis of teeth #31, #32, and #41, after evaluation through a clinical examination and cone-beam computed tomography (CBCT). At the first appointment, these teeth were subjected to conventional endodontic treatment. At 6- and 12-month follow-up visits, the patient complained of persistent pain associated with the endodontically treated teeth (mainly in tooth #31), despite complete remission of the periapical lesions shown by radiographic and CBCT exams proving the effectiveness of the endodontic treatments, thus indicating a probable diagnostic of persistent pain of non-odontogenic nature. After the surgical procedure was performed to curette the lesion and section 3 mm of the apical third of tooth #31, the histopathological analysis suggested that the painful condition was likely associated with the patient's systemic condition. Based on clinical, radiographic, and histopathological findings, this unusual case report suggests that WG may be related to non-odontogenic persistent pain after successful endodontic treatments.

Citations

Citations to this article as recorded by  

• Toothaches of Non-odontogenic Origin
  Davis C. Thomas, Tanvee Somaiya, Ahana Ajayakumar, Vaishnavi Prabhakar
  Dental Clinics of North America.2026; 70(1): 209.     CrossRef

Citations

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  Journal of Endodontics.2025; 51(7): 845.     CrossRef
• Immunohistochemical Analysis of CD117 in the Mast Cells of Odontogenic Keratocysts
  Sujatha Varma, Shameena PM, Plakkil Viswanathan Deepthi, Indu G
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  International Endodontic Journal.2023; 56(8): 980.     CrossRef

This is a case report of chronic maxillary sinusitis caused by root canal overfilling of Calcipex II (Techno-Dent). A 60 year-old male complained of dull pain in the right maxillary molar area after complicated endodontic treatment using Calcipex II paste and was finally diagnosed with a chronic maxillary sinusitis through a clinical and radiological observation. In the biopsy examination, the periapical granuloma contained a lot of dark and translucent Calcipex II granules which were not stained with hematoxylin and eosin. They were usually engulfed by macrophages but rarely resorbed, resulting in scattering and migrating into antral mucosa. Most of the Calcipex II granules were also accumulated in the cytoplasms of secretory columnar epithelial cells, and small amount of Calcipex II granules were gradually secreted into sinus lumen by exocytosis. However, chronic granulomatous inflammation occurred without the additional recruitment of polymorphonuclear leukocytes (PMNs) and lymphocytes, and many macrophages which engulfed the Calcipex II granules were finally destroyed in the processes of cellular apoptosis. It is presumed that Calcipex II granules are likely to have a causative role to induce the granulomatous foreign body inflammation in the periapical region, and subsequently to exacerbate the chronic maxillary sinusitis in this study.

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  Ear, Nose & Throat Journal.2025;[Epub]     CrossRef
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  Mi-Ah Kim, Min-Kyeong Kim, Eun-Sook Kang, Kyung-San Min
  Journal of Oral Science.2025; 67(1): 35.     CrossRef
• The effect of extrusion of the filling material on the periapical status
  M. Yu. Pokrovsky, T. P. Goryacheva, A. М. Pokrovskiy, O. А. Aleshina
  Endodontics Today.2025; 23(1): 31.     CrossRef
• Rheological properties and handling characteristics of four injectable calcium hydroxide pastes
  Min-Jung KIM, In-Bog LEE
  Dental Materials Journal.2024; 43(6): 796.     CrossRef
• Assessing the efficacy of jet dispenser versus direct syringe injection for calcium hydroxide paste placement in artificial root canals
  Youngwook Song, Hwichan Ham, WooCheol Lee, Ryan Jin Young Kim
  Scientific Reports.2023;[Epub]     CrossRef
• A white cloud in the antrum: Maxillary sinusitis following an endodontic treatment
  Kamis Gaballah, Mawada Hassan
  Asian Journal of Surgery.2023; 46(4): 1690.     CrossRef
• Electronic Apex Locators and their Implications in Contemporary Clinical Practice: A Review
  Zainab Shirazi, Anas Al-Jadaa, Abdul Rahman Saleh
  The Open Dentistry Journal.2023;[Epub]     CrossRef
• The significance of diagnosis and treatment planning in periapical lesion overfilled with calcium hydroxide paste
  Kyoung-Hwa Jung, Eun-Young Kwon, Youn-Kyung Choi, So-Yeun Kim, Hye-Mi Jeon, Jeong-Kil Park
  Journal of Dental Rehabilitation and Applied Science.2021; 37(2): 95.     CrossRef
• Maxillary antroliths detected by cone-beam computed tomography in an adult dental population
  Bong-Hae Cho, Yun-Hoa Jung, Jae-Joon Hwang
  Imaging Science in Dentistry.2019; 49(1): 59.     CrossRef
• Influence of the Maxillary Sinus on the Accuracy of the Root ZX Apex Locator: An Ex Vivo Study
  Roula El Hachem, Elie Wassef, Nadim Mokbel, Richard Abboud, Carla Zogheib, Nada El Osta, Alfred Naaman
  Dentistry Journal.2019; 7(1): 3.     CrossRef
• Removal efficacy and cytotoxicity of a calcium hydroxide paste using N-2-methyl-pyrrolidone as a vehicle
  Myung-Jin Lim, Hyun-Jin Jang, Mi-Kyung Yu, Kwang-Won Lee, Kyung-San Min
  Restorative Dentistry & Endodontics.2017; 42(4): 290.     CrossRef
• A case of high density abnormality in x-ray findings of mandible caused by leakage of root canal filling paste
  Haruko Kashiwamura, Kyoko Oka, Yoko Tuchihashi, Hanako Yoshioka, Mayumi Kato, Atsuko Baba, Toyohiro Kagawa, Kazuhiko Okamura, Masao Ozaki
  Pediatric Dental Journal.2017; 27(3): 162.     CrossRef
• Maxillary Sinus Impaction of a Core Carrier Causing Sustained Apical Periodontitis, Sinusitis, and Nasal Stenosis: A 3-year Follow-up
  Lars Bjørndal, Catharina Amaloo, Merete Markvart, Vibe Rud, Klaus Qvortrup, Camilla Stavnsbjerg, Thomas Bjarnsholt
  Journal of Endodontics.2016; 42(12): 1851.     CrossRef
• Proximity of Posterior Teeth to the Maxillary Sinus and Buccal Bone Thickness: A Biometric Assessment Using Cone-beam Computed Tomography
  Sung Hyun Kang, Bom Sahn Kim, Yemi Kim
  Journal of Endodontics.2015; 41(11): 1839.     CrossRef

The purpose of this study was to find out the relationship of radiographic lesion size, gender, age of patients and radiographic character to the diagnosis of periapical cyst and granuloma.

The data was collected from 187 periapical lesions of 167 patients who undergone apical surgery at Department of Conservative Dentistry, Seoul National University Dental Hospital from 2003 to 2005. The lesion were surgically removed and send for biopsy to the Oral Pathology Laboratory. From the initial radiograph, lesion size was calculated using PiViewSTAR® (INFINITT, Korea) program. The obtained data were statistically evaluated using SPSS (p < 0.05).

The result were as followings:

From 187 biopsy samples, the incidence of periapical cyst was 28.34% and granuloma was 65.24%.