case_images: PMC10880484_01
case_images: (a) Preoperative periapical radiograph, (b) Orthograde Mineral Trioxide Aggregate Obturation i.r.t. 22, (c) Preoperative intraoral clinical photograph, (d and e) shows the cone-beam computed tomography (CBCT) slices depicting extension of the lesion in all view, (f and g) shows planning of three-dimensional printed template using CBCT imaging
case_images: JCDE-27-105-g001.jpg
case_images: PMC10880484_01_JCDE-27-105-g001.jpg
case_images: JCDE_178_23-f001
case_images: Clinical examination revealed fractured tooth in relation to 22 with extraoral swelling extending from the lower border of the infraorbital margin to the upper lip [Figure 1a and c]. Intraoral periapical radiograph (IOPA) revealed a large periapical radiolucency in relation to 22, extending from the distal surface of 21 to the mesial surface of 23 [Figure 1a]. Despite the enormous size of the lesion, the buccal cortical plate was completely intact [Figure 1d and e]. The inner diameter of the template was designed to be smaller than the lesion size but large enough to access the cystic lining in most peripheral parts [Figure 1f and g]. The template was printed using stereolithography technology [Figure 1f]. Orthograde mineral trioxide aggregate (MTA) (ProRoot MTA, Dentsply Tulsa Dental, Johnson City, USA) obturation was performed 24 h before the surgery in relation to 22 [Figure 1b].
case_images: (a) Three-dimensional printed template, (b) Checking the fit of the template before the surgery, (c) Bone window made to preserve the buccal cortical bone plate, (d) Follow-up after 3 months, (e) After root resection, (f) Placement of bone cement at three strategic locations over the bone plate for stabilizing, (g) Radiograph postroot resection, (h) Follow-up after 12 months, (i) A schematic diagram explaining the bone cement placement. Three strategic locations as follows: I: Superomedially, II: Inferomedially, III: Laterally
case_images: JCDE-27-105-g002.jpg
case_images: PMC10880484_01_JCDE-27-105-g002.jpg
case_images: JCDE_178_23-f002
case_images: The surgical template went through a stabilization check [Figure 2a and b]. This cut had a straight access and was made with the help of long shank straight fissure (Bur no. 702, SS white) surgical bur at slow speed [Figure 2c]. Root end was resected up to 3 mm, exposing the MTA-filled canal [Figure 2e and g]. Manipulation of the cement was carried out as per the manufacturer's instructions where achieving a "dough" consistency was the goal [Figure 2f]. After 3 and 12 months of follow-up, the patient was asymptomatic and IOPA revealed a completely healed site [Figure 2d and h].