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• W2790798984 abstract "We read with interest the case report involving an odontogenic keratocyst.1Leandro Santos R.S. Ramos-Perez F.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 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. We wish to highlight several issues that may be helpful for AJO-DO readers. Figure 1 in the article illustrates a midradicular radiolucency between 2 teeth. Radiolucencies of endodontic origin normally appear apically. A periapical radiograph is mandatory for endodontic diagnosis; however this, together with intraoperative and postoperative views, is absent. Pulpal necrosis is unlikely to be associated with positive sensibility testing, vis-à-vis “pulp vitality testing” that is instead associated with blood flow. If vital tissue was present during endodontic treatment, one should be highly suspicious that the lesion is nonendodontic. It would be valuable to have this information. After “satisfactory endodontic treatment,” failure of treatment may still occur; it is a risk associated with any medical or surgical intervention. Thus, as part of the shared decision-making process, clinicians must inform patients of differential diagnoses, steps to reach a definitive diagnosis, and treatment options with their inherent benefits and risks, when obtaining informed consent.2Rossi-Fedele G. Musu D. Cotti E. Doğramacı E.J. Root canal treatment versus single-tooth implant: a systematic review of Internet content.J Endod. 2016; 42: 846-853Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar Missed diagnosis and delayed management of pathologic lesions can lead to litigation due to the negative impact on a patient's quality of life.3Steier L. Steier G. Doğramacı E.J. Rossi-Fedele G. Maxillary sinus aplasia as an incidental finding following cone-beam computed (volumetric) tomography.Aust Endod J. 2014; 40: 26-31Crossref PubMed Scopus (3) Google Scholar Reporting of radiographic images should always be performed by the operator exposing the radiograph or the requesting clinician, so that the opportunity to fully use the diagnostic yield of a radiograph, for the benefit of the patient, is not missed.3Steier L. Steier G. Doğramacı E.J. Rossi-Fedele G. Maxillary sinus aplasia as an incidental finding following cone-beam computed (volumetric) tomography.Aust Endod J. 2014; 40: 26-31Crossref PubMed Scopus (3) Google Scholar Occasionally, the information may be beyond the diagnostic interpretation of the requesting clinician, in case which the radiograph should be referred to a radiologist. In this patient, orthodontic treatment commenced in the presence of an undiagnosed lesion. More than a year passed before the patient was referred, misdiagnosed for endodontic treatment, after which orthodontic treatment continued. Orthodontic treatment was abandoned only after histologic tests confirmed the nature of the lesion. Such lesions must be prioritized for management, since they are classified as having high-grade clinical importance requiring immediate attention.4Doğramacı E.J. Rossi-Fedele G. McDonald F. Clinical importance of incidental findings reported on small-volume dental cone beam computed tomography scans focused on impacted maxillary canine teeth.Oral Surg Oral Med Oral Surg Oral Radiol. 2014; 118: e205-e209Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar Recently, ultrasonography has been recommended for the differential diagnosis of bony jaw lesions, including odontogenic keratocysts.5Musu D. Rossi-Fedele G. Campisi G. Cotti E. Ultrasonography in the diagnosis of bone lesions of the jaws: a systematic review.Oral Surg Oral Med Oral Surg Oral Radiol. 2016; 122: e19-e29Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar Odontogenic keratocyst: The role of the orthodontist in the diagnosis of initial lesionsAmerican Journal of Orthodontics and Dentofacial OrthopedicsVol. 152Issue 4PreviewOdontogenic keratocysts (OKCs) are locally infiltrative odontogenic cysts that are usually diagnosed during routine radiographic examinations. Therefore, it is critical that dental practitioners, in particular orthodontists, recognize and diagnose OKCs to recommend appropriate treatment. This report describes a patient whose OKC was not initially identified during orthodontic pretreatment. In addition, this report discusses the clinical and radiographic features of OKCs, as well as the differential diagnoses of these lesions. Full-Text PDF Authors' responseAmerican Journal of Orthodontics and Dentofacial OrthopedicsVol. 153Issue 2PreviewWe thank Dr Doğramacı and Dr Rossi-Fedele for their interest in our article, which reports an undiagnosed and neglected odontogenic keratocyst before orthodontic treatment.1 Full-Text PDF" @default.
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• W2790798984 title "Odontogenic keratocyst: the pitfalls of uncoordinated multidisciplinary care" @default.
• W2790798984 doi "https://doi.org/10.1016/j.ajodo.2017.10.019" @default.
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