Diagnostic perplexity of panoramic radiograph.

To cite: Badar SB, Ghafoor R. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2016216353 DESCRIPTION A 14-year-old girl presented to the dental clinic with a history of a fall and blow to her upper front teeth. After initial management by the oral surgeon she was referred to the endodontic department for the management of her fractured maxillary incisors. Her medical history was unremarkable. Intraoral examination revealed complicated crown fracture on maxillary central and lateral incisors. Panoramic radiograph (figure 1) showed fractured maxillary incisors involving pulp and horizontal root fracture at apical third of tooth number 21(Fédération Dentaire Internationale) that raised a question to the prognosis of this tooth. Since panoramic views are not a good diagnostic tool to assess anterior teeth, we had taken occlusal view (figure 2) and periapical view radiographs (figure 3) at different angles to confirm horizontal root fracture. These radiographs showed a completely different scenario. We could see a separate mass (odontome/supernumerary tooth) having a canal space, adjacent to the root of tooth number 21 and the root of the