Abstract
Periapical lesions with mixed radiographic appearance can have odontogenic or nonodontogenic origin. A number of neoplastic lesions either benign or malignant can present as radiolucent, radiopaque, or mixed in jaws and if present near the root apices can be misdiagnosed as odontogenic infection/etiology. The present case report describes a rare case of two elongated radiopaque structures within periapical pathology located beneath the apices of mandibular central incisors in a 26-year-old male. Further, it describes its nonsurgical and surgical endodontic management along with histological confirmation and long-term radiographic healing outcome using cone-beam computed tomography. Microscopic examination revealed the presence of dentin and cementum with fringes of periodontal ligament suggestive of tooth-like structures. No case report has yet reported tooth-like calcifications within the large periapical lesion. Biopsy of such lesions is deemed necessary to differentiate from nonodontogenic lesions which could be benign or malignant in nature.