case_images: PMC10978518_01
case_images: Ellis class IV fracture with a sinus
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case_images: F1
case_images: The medical history was noncontributory, and the clinical examination revealed an Ellis class IV fracture in the permanent maxillary right central incisor with a sinus on the labial mucosa near the root apex (Fig. 1).
case_images: Radiograph revealing a large blunderbuss canal
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case_images: F2
case_images: The tooth was unresponsive to electric as well as thermal pulp sensibility tests and a thorough radiographic examination showed a large blunderbuss canal with associated periapical lesion and resorption on the mesial aspect of the tooth (Fig. 2).
case_images: Access cavity under rubber dam isolation
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case_images: F3
case_images: Rubber dam isolation was done, followed by access cavity preparation (Fig. 3), and working length determination was done with #60H file (Mani, Prime Dental Product Pvt.
case_images: Working length determination
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case_images: F4
case_images: Ltd., India) (Fig. 4).
case_images: WorkingThe canal was dried with a sterile paper point
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case_images: F5
case_images: Amplemeds, India), followed by internal heating and activation 5 mm above the working length. After that, the canal was dried with sterile paper points (Diadent, Chungju, Korea) (Fig. 5).
case_images: Hemostatic collagen sponge in the apical third of the root canal at 25x
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case_images: F6
case_images: After drying the root canal, with the help of an endodontic condenser (Meta Biomed, Chungcheongbuk-do, Korea), a small fragment of hemostatic collagen sponge (Hemospon; Technew, Rio de Janeiro, Brazil) was introduced and placed in the apical third of the root canal with the help of a prefitted plugger until the working length (Fig. 6).
case_images: Clinical picture showing MTA's first increment at 25x
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case_images: F7
case_images: Technew, Rio de Janeiro, Brazil) was compacted. The mixture was carried to the canal using the micro-apical placement (MAP) system (Produits Dentaires SA, Vevey, Switzerland) (Fig. 7) under magnification which was placed increment by increment and each increment was condensed with paper point (Diadent, Chungju, Korea) and a prefitted plugger (Meta Biomed, Chungcheongbuk-do, Korea) to create the 5 mm plug (Fig. 8).
case_images: Radiograph confirming 5 mm MTA plug
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case_images: F9
case_images: A radiograph was taken to check the precise placement of MTA at the apex (Fig. 9).
case_images: Master cone using the inverted cone technique
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case_images: F10
case_images: After the initial set, the master cone was taken using the inverted cone technique (Fig. 10) and the canal was obturated using bioceramic sealer (Ceraseal, Meta Biomed, Chungcheongbuk-do, Korea) and gutta-percha (Diadent, Chungju, Korea) with warm vertical condensation to create the 3D seal and the post endodontic composite (Tetric N-Ceram, Ivoclar Vivadent, Schaan, Liechtenstein) restoration was also completed on the same visit (Fig. 11).
case_images: The 6- and 9-month follow-up showing periapical healing
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case_images: F12
case_images: On follow-up recalls, the tooth was asymptomatic and the 6 and 9 months of postoperative radiographs showed significant healing of the periapical lesion (Fig. 12).