case_images: PMC7707965_01
case_images: Extraoral examination revealed a left mandibular swelling.
case_images: CRID2020-8876268.001.jpg
case_images: PMC7707965_01_CRID2020-8876268.001.jpg
case_images: fig1
case_images: The overlying skin was unremarkable, and no fluctuance or discharge was noted (Figure 1).
case_images: (a) A penetrating carious lesion in the first left mandibular molar. (b) Two sinus tract in relation with the first left mandibular molar.
case_images: CRID2020-8876268.002.jpg
case_images: PMC7707965_01_CRID2020-8876268.002.jpg
case_images: fig2
case_images: (a) Periapical radiograph revealed a not limited periapical lesion. (b) Occlusal radiograph revealed a periostitis reaction in relation with the external cortex.
case_images: CRID2020-8876268.003.jpg
case_images: PMC7707965_01_CRID2020-8876268.003.jpg
case_images: fig3
case_images: The periapical radiograph showed a periapical lesion in relation to the two root canals of the left mandibular first molar (Figure 3(a)).
case_images: Sinus tract disappearance after 1 week.
case_images: CRID2020-8876268.004.jpg
case_images: PMC7707965_01_CRID2020-8876268.004.jpg
case_images: fig4
case_images: (a) Clinical healing after 4 months with extraoral swelling disappearance. (b) Periapical radiographic control after 8 months showed periapical lesion regression. (c) Occlusal radiograph showed periostitis disappearance after 4 months.
case_images: CRID2020-8876268.005.jpg
case_images: PMC7707965_01_CRID2020-8876268.005.jpg
case_images: fig5
case_images: PMC7707965_02
case_images: First mandibular molar with periapical lesions appended to the two root apices.
case_images: CRID2020-8876268.006.jpg
case_images: PMC7707965_02_CRID2020-8876268.006.jpg
case_images: fig6
case_images: Computed tomography exam: (a) Coronal section showing "onion skin" aspect of lateral periostitis and the radiolucency in relation with first molar's roots. (b) Axial section showing periostitis in both external and internal mandibular cortex with lateral rupture of the cortical. (c) Sagittal section showing radiolucency in relation with first molar's roots.
case_images: CRID2020-8876268.007.jpg
case_images: PMC7707965_02_CRID2020-8876268.007.jpg
case_images: fig7
case_images: 3D reconstruction showing the bone formation associated with cortical's rupture.
case_images: CRID2020-8876268.008.jpg
case_images: PMC7707965_02_CRID2020-8876268.008.jpg
case_images: fig8
case_images: This was also confirmed by 3D reconstruction (Figure 8).
case_images: (a) Pulp stone in the chamber obliterating canal orifices. (b) Widen the canal orifices with ultrasonic tips.
case_images: CRID2020-8876268.009.jpg
case_images: PMC7707965_02_CRID2020-8876268.009.jpg
case_images: fig9
case_images: In fact, the patient did not report any pain history (Figure 9(a)). It was eliminated with ultrasonic tips (Figure 9(b)).
case_images: (a) Postoperative periapical radiograph after 4 months with signs of bone healing. (b) Occlusal radiograph after 4 months: partial disappearance of the periostitis.
case_images: CRID2020-8876268.010.jpg
case_images: PMC7707965_02_CRID2020-8876268.010.jpg
case_images: fig10
case_images: (a) Reduction of the periapical lesion size on the periapical radiograph after 8 months. (b) Occlusal radiograph showed total resolution of the periostitis after 8 months. (c) Periapical radiograph after 12 months: total regression of the apical radiolucency.
case_images: CRID2020-8876268.011.jpg
case_images: PMC7707965_02_CRID2020-8876268.011.jpg
case_images: fig11
case_images: At the 8-month follow-up, the periapical radiograph showed a reduction of more than half of the primary periapical lesion size (Figure 11(a)). The occlusal radiograph revealed total healing of the periostal reaction (Figure 11(b)).
case_images: Periapical radiograph after 20 months: total regression of the apical radiolucency.
case_images: CRID2020-8876268.012.jpg
case_images: PMC7707965_02_CRID2020-8876268.012.jpg
case_images: fig12