case_images: PMC10988638_01
case_images: A) Initial periapical radiographic image of tooth #22; indicating the presence of a large radiolucent area in the apical region; B) Facial asymmetry and increased volume on the left side
case_images: IEJ-19-134-g001.jpg
case_images: PMC10988638_01_IEJ-19-134-g001.jpg
case_images: F1
case_images: Periapical radiographic examination revealed a periradicular lesion and obliteration of the root canal in the cervical and middle thirds (Figure 1A). Intraoral clinical examination showed a color change in tooth 22, as well as swelling in the apical region and acute persistent pain (Figure 1B).
case_images: A) Sagittal section showing obliterated canal in the cervical third and rupture of cortical bone through the vestibular; B) Coronal section demonstrating extensive periapical lesion; C) Axial section showing obliteration of the canal in the cervical third
case_images: IEJ-19-134-g002.jpg
case_images: PMC10988638_01_IEJ-19-134-g002.jpg
case_images: F2
case_images: The tomographic images were obtained in the sagittal, coronal and axial planes and careful assessment showed the presence of PCO in the cervical third and the beginning of middle third (Figures 2A-2C). 
case_images: A) Periapical radiograph confirming canal location with #10 k file; B) Periapical radiograph showing the intracanal medication; calcium hydroxide; C) Periapical radiograph immediately after the endodontic treatment of tooth #22; D) Periapical radiograph after one year follow-up
case_images: IEJ-19-134-g003.jpg
case_images: PMC10988638_01_IEJ-19-134-g003.jpg
case_images: F3
case_images: After selective wear, an access cavity was identified and a #10K C-Pilot file (VDW, Munich, Germany) was inserted for radiographic confirmation (Figure 3A). The medication was kept in the canal for 15 days to increase penetrability of the dentinal tubules and to reduce the microbial load (Figure 3B). EndoSequence BC Sealer (Brasseler USA, Savannah, GA, USA) was used as endodontic cement and the crown was sealed with a 3-mm Bulk Fill Flow A3 plug (3M ESPE, Saint Paul, MN, USA), followed by restoration with Z350 A3B resin (3M ESPE) on the palatal surface (Figure 3C). A follow-up periapical radiograph was obtained to compare regression of the lesion, which revealed evident bone repair (Figure 3D).
case_images: A) Sagittal section confirmed repair of periradicular tissues after three years; B) Coronal section showing the tomographic appearance of tooth #22 demonstrating good sealing of the root canal after 2 years of follow-up
case_images: IEJ-19-134-g004.jpg
case_images: PMC10988638_01_IEJ-19-134-g004.jpg
case_images: F4
case_images: After 3 years of follow-up, a CBCT scan confirmed repair of the periradicular tissues (Figure 4A and 4C).