case_images: PMC10777889_01
case_images: Intraoral preoperative periapical radiograph. A large radiolucency was observed in the radiographic examination, extending from the left lateral incisor to the right lateral incisor, showing at the root apex and displacing the roots of both mandibular incisors.
case_images: cureus-0016-00000052020-i01.jpg
case_images: PMC10777889_01_cureus-0016-00000052020-i01.jpg
case_images: FIG1
case_images: Radiographic images, including periapical or cone-beam computed tomography (CBCT) scans, were acquired during every subsequent examination (Figures 1-4).
case_images: (A) Cone-beam computed tomography (CBCT) (Reconstructed). (B) Lateral view. (C) Axial view. The imaging procedures detected the presence of a well-demarcated, non-corticated, pear-shaped radiolucent lesion in the anterior region of the mandible, extending from tooth #33 to tooth #43 (Figure 2A). The lesion caused the slight separation of roots of the lower central incisors, breached the buccal plate of bone, and thinned and eroded the lingual plate of bone (Figure 2B). There is evidence of faint septation within the lesion (Figure 2C). The soft tissue component of the lesion extended to the overlying labial soft tissues (Figure 2C). Based on the observed location and behavioral patterns, central giant cell granuloma is the most likely diagnosis. However, inflammatory cysts and keratocysts cannot be excluded.
case_images: cureus-0016-00000052020-i02.jpg
case_images: PMC10777889_01_cureus-0016-00000052020-i02.jpg
case_images: FIG2
case_images: Radiographic images, including periapical or cone-beam computed tomography (CBCT) scans, were acquired during every subsequent examination (Figures 1-4).
case_images: (A) Postoperative radiograph after non-surgical root canal treatment. (B) Intraoperative photograph. The lesion after flap reflection. (C) Suture removal after 5 days. (D) Postoperative radiograph after root canal surgical treatment of the lower left central incisor.. The dental procedure involved isolating the tooth with a rubber dam, followed by canal access, cleaning, and shaping to the entire working length. Subsequently, a hydraulic condensation technique was used to obturate the canal using a bio-ceramic sealer (Endosequence BC Sealer)(Figure 3A). The tooth was scheduled for apicoectomy and surgical excision of the lesion (Figure 3B). During the second scheduled visit, microsurgical root canal treatment was performed using ProRoot MTA. The lesion was enucleated and subsequently sent for histopathological examination, which revealed a periapical granuloma.
case_images: cureus-0016-00000052020-i03.jpg
case_images: PMC10777889_01_cureus-0016-00000052020-i03.jpg
case_images: FIG3
case_images: Radiographic images, including periapical or cone-beam computed tomography (CBCT) scans, were acquired during every subsequent examination (Figures 1-4).
case_images: (A) Periapical radiograph after 12, (B) 24 and (C) 36 months' follow-up. A subsequent examination was conducted after 12, 24, and 36 months (follow-up) (Figure 4A-4C), which revealed a decrease in the size of the lesion. Additionally, no pain was reported during percussion and palpation. Furthermore, there was no observation of vestibular swelling.
case_images: cureus-0016-00000052020-i04.jpg
case_images: PMC10777889_01_cureus-0016-00000052020-i04.jpg
case_images: FIG4
case_images: Radiographic images, including periapical or cone-beam computed tomography (CBCT) scans, were acquired during every subsequent examination (Figures 1-4).