case_images: PMC11377115_01
case_images: Clinical examination of Tooth #46.
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case_images: fig1
case_images: A 29-year-old male patient with a temporary filling of the Mandibular Right Tooth #46 (Figure 1) was referred to the Conservative Department of Prof.
case_images: Preoperative radiograph.
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case_images: fig2
case_images: A radiographic examination of the furcal region of 46 showed a radiolucent area and external resorption (Figure 2).
case_images: Root canal treatment under rubber dam isolation.
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case_images: fig3
case_images: During the first visit, the access cavity was prepared, and initial negotiation was done with a No. 15 stainless steel hand K-file (M-access; Dentsply Maillefer, Ballaigues, Switzerland) under strict rubber dam isolation (Figure 3).
case_images: Postoperative radiograph.
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case_images: fig4
case_images: Obturation was carried out by using epoxy resin (AH Plus, Dentsply), and periapical radiograph evaluation was performed (Figure 4).
case_images: Cone beam computed tomography (CBCT) of Tooth #46 before periodontal surgery. (a) Sagittal view, (b) coronal view, and (c) axial view.
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case_images: fig5
case_images: Periapical lesions that expand distally could still be observed on the sagittal view (Figure 5(a)). External resorption in the furcation area and bone loss at the one-third buccal cervical were revealed (Figures 5(b) and 5(c)).
case_images: Triangular incision.
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case_images: fig6
case_images: Teeth 47 and 45 with a No. 15c blade, a modified Widman flap was executed on Tooth 46, and a vertical incision was performed on Mesial Tooth 45. The interdental papilla area was left alone and deepitelized with a 15c blade to preserve the papilla (Figure 6).
case_images: Debridement.
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case_images: fig7
case_images: A Gracey curette (Osung, South Korea) and an ultrasonic scaler were used to debride and clean the furcation area of Tooth 46 after the full-thickness flap had been reflected (Figure 7).
case_images: Biodentine application on root resorption.
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case_images: fig8
case_images: Then, the roots were conditioned with EDTA gel and rinsed with saline (Figure 8).
case_images: Bone graft and membrane application.
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case_images: fig9
case_images: The DFDBA bone graft (Batan, Indonesia) was inserted into the area of the bone defect, completely filling the furcation surface, and then coated with a collagen membrane (Collacure, USBIO , China) sewn together with 5.0 monophytic thread (Figure 9).
case_images: Suturing.
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case_images: fig10
case_images: Simple and sling sutures with 4.0 nylon thread were used to seal and stitch the flaps (Figure 10).
case_images: Periodontal dressing application.
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case_images: fig11
case_images: In addition to giving the patient health instructions, a periodontal dressing (Coe-Pack, GC, Japan) was placed on the surgical area (Figure 11).
case_images: Crown insertion at Tooth #46.
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case_images: fig12
case_images: One week later, composite crowns were bonded to the tooth (Figure 12).
case_images: Cone beam computed tomography (CBCT) of Tooth #46 at 3-month follow-up. (a) Sagittal view, (b) coronal view, and (c) axial view.
case_images: CRID2024-1048933.013.jpg
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case_images: fig13
case_images: The periapical and furcation areas showed indications of new bone formation, which was characterised by radiolucent areas that gradually shifted to radiopaque (Figures 13(a), 13(b), and 13(c)).
case_images: Cone beam computed tomography (CBCT) of Tooth #46 at 6-month follow-up. (a) Sagittal view, (b) coronal view, and (c) axial view.
case_images: CRID2024-1048933.014.jpg
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case_images: fig14
case_images: CBCT on the sagittal view showed compacted bone in the periapical area which has a similar appearance to the surrounding normal bone trabecular (Figure 14(a)), while bone defect in the furcation area has remained as seen in the coronal and axial views (Figures 14(b) and 14(c)).
case_images: CBCT (a, d, g) before periodontal treatment, (b, e, h) 3 months, and (c, f, i) 6 months of follow-up arranged sequentially, consisting of coronal, sagittal, and axial views.
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case_images: fig15
case_images: Comparison of the condition of Tooth 46 and the periapical status before surgery, after surgery, and after a 6-month follow-up evaluated through CBCT imaging (Figure 15).