title: Multiple periradicular radiolucencies mimicking endodontic lesions in renal osteodystrophy of the mandible: a case report.
abstract: OBJECTIVE
  To report a finding of multiple periapical radiolucencies mimicking endodontic lesions in a patient with renal osteodystrophy of the mandible.
  
  
  CONCLUSIONS
  A 47-year-old woman was referred by her general dentist to the postgraduate endodontic clinic for assessment and root canal treatment of multiple teeth with associated periapical radiolucencies. The patient's medical history included chronic renal failure. All mandibular teeth with periapical radiolucencies except tooth 37 had positive responses to pulp sensibility testing. A diagnosis of pulpal necrosis and associated periapical periodontitis was made on tooth 37, and root canal treatment was carried out. To determine the possible relationship between the patient's renal disease and the multiple periapical radiolucencies, an additional physician consultation and laboratory tests were requested. Secondary hyperparathyroidism was confirmed with the laboratory report showing an elevated level of parathyroid hormone and a normal serum calcium level. Renal osteodystrophy of the mandible caused by secondary hyperparathyroidism was the probable aetiology of the multiple mandibular periapical radiolucencies, and no root canal treatment was required. Key learning points Renal osteodystrophy of the mandible caused by secondary hyperparathyroidism can present as multiple periapical radiolucencies but is a rare finding. Diverse orofacial manifestations such as loss of lamina dura, widening of periodontal ligament and demineralization of bone can be observed in renal osteodystrophy. Thorough clinical and radiographic assessment along with the review of patient's medical history and haematological analysis is essential for the diagnosis of renal osteodystrophy.
authors.affiliation: Division of Endodontics, Columbia University College of Dental Medicine, New York, NY, USA.
authors.forename: P
authors.initials: P
authors.lastname: Jalali
authors.affiliation: Division of Endodontics, Columbia University College of Dental Medicine, New York, NY, USA.
authors.forename: S G
authors.initials: SG
authors.lastname: Kim
keywords: differential diagnosis; periradicular radiolucency; renal osteodystrophy; secondary hyperparathyroidism