Multimodular assessment of a calcified extraradicular deposit on the root surfaces of a mandibular molar.

Aim: To achieve a better understanding of a calcified extraradicular deposit on the apical root surfaces of a mandibular first molar associated with a radicular cyst and a sinus tract. A multimodular approach was applied using a combination of multiple investigation methods. Summary: This case report presents a mandibular first molar with a calcified extraradicular deposit on the apical root surfaces of both roots. An apical periodontitis lesion was present and a sinus tract served as the only communication with the oral cavity. Diagnosis and treatment planning were based on clinical, radiographic (two- and three-dimensional) and ultrasound examination. The tooth was further analysed after extraction using microscopic imaging, nano-computed tomography (nano-CT), hard- and soft tissue histology and electron probe microanalysis. This multimodular approach revealed the calculus-like appearance and mineral composition of the extraradicular deposit. Multiple hypotheses about its aetiology are discussed. Key learning points: Calcified extraradicular deposits can develop on the apical root surfaces of teeth with apical periodontitis in association with a radicular cyst and sinus tract. A sinus tract can serve as the only communication between the apical lesion and the oral cavity whilst no periodontal defects are present. The interplay of intra-oral radiography, high resolution CBCT, nano-CT, hard tissue histology and EPMA can reveal the calculus-like appearance and composition of the extraradicular deposit. Calcified extraradicular deposits appear hyperechoic on ultrasound imaging and can lead to the occurrence of twinkling artefacts due to their rough mineralized surface.