case_images: PMC10896276_01
case_images: Preoperative coronal section of the cone-beam computed tomography (CBCT) image reveals large periapical lesions in teeth #31, #41, #32, and #42, indicated by red and yellow arrows
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case_images: PMC10896276_01_cureus-0016-00000053066-i01.jpg
case_images: FIG1
case_images: Cone-beam computed tomography (CBCT) images revealed large periapical lesions associated with teeth #31, #41, #32, and #42 (Figure 1).
case_images: Preoperative and nine-month follow-up 3D reconstructions of cone-beam computed tomography (CBCT) images. (A) The preoperative 3D reconstruction of the CBCT image reveals buccal bone plate fenestration in the apical areas of teeth #31 (yellow arrow) and #41 (red arrow). (B) The 3D reconstruction of the CBCT image from the nine-month follow-up shows significant healing of the periapical lesions in teeth #31 (yellow arrow) and #41 (red arrow).
case_images: cureus-0016-00000053066-i02.jpg
case_images: PMC10896276_01_cureus-0016-00000053066-i02.jpg
case_images: FIG2
case_images: The 3D reconstruction of the CBCT images showed buccal bone plate fenestration in teeth #31 and #41 (Figure 2A). CBCT image revealed that the periapical lesions had significantly resolved (Figure 2B). Cross-sectional CBCT images in the coronal (Figure 4D), middle (Figure 4E), and apical thirds (Figure 4F) of the tooth roots showed that the large periapical lesions along the roots of teeth #31, #41, #32, and #42 had also significantly resolved.
case_images: The preoperative cross-sectional cone-beam computed tomography image at the cementoenamel junction level reveals that the mesial aspects of the pulp chamber walls of teeth #31 (yellow arrow) and #41 (red arrow) were almost perforated
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case_images: PMC10896276_01_cureus-0016-00000053066-i03.jpg
case_images: FIG3
case_images: The cross-sectional CBCT images at the cementoenamel junction level indicated near perforations in the mesial aspects of the pulp chamber walls of teeth #31 and #41 (Figure 3).
case_images: Preoperative and nine-month follow-up cross-sectional cone-beam computed tomography (CBCT) images. (A-C) Preoperative cross-sectional CBCT images of the coronal (A), middle (B), and apical (C) thirds of tooth roots, showing periapical lesions (red arrows) and buccal bone plate fenestration (yellow arrow). (D-F) Nine-month follow-up cross-sectional CBCT images in the coronal (D), middle (E), and apical (F) thirds of the tooth roots, demonstrating significant healing of the periapical lesions (red arrows) and buccal bone plate fenestration (yellow arrow).
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case_images: PMC10896276_01_cureus-0016-00000053066-i04.jpg
case_images: FIG4
case_images: Further, CBCT images in the coronal (Figure 4A), middle (Figure 4B), and apical (Figure 4C) thirds of these tooth roots showed extensive periapical lesions. CBCT image revealed that the periapical lesions had significantly resolved (Figure 2B). Cross-sectional CBCT images in the coronal (Figure 4D), middle (Figure 4E), and apical thirds (Figure 4F) of the tooth roots showed that the large periapical lesions along the roots of teeth #31, #41, #32, and #42 had also significantly resolved.
case_images: Preoperative and nine-month follow-up sagittal sections of cone-beam computed tomography (CBCT) images. (A-D) The preoperative sagittal sections of the CBCT images display periapical lesions (yellow arrows) in teeth #42 (A), #41 (B), #31 (C), and #32 (D). The images also show that the root canals (red arrows) in teeth #41 (B) and #31 (C) were calcified and not visible. (E-H) The sagittal sections of the CBCT images taken at the nine-month follow-up demonstrate significant healing of the periapical lesions (yellow arrows) in teeth #42 (E), #41 (F), #31 (G), and #32 (H).
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case_images: PMC10896276_01_cureus-0016-00000053066-i05.jpg
case_images: FIG5
case_images: The sagittal sections of the CBCT images highlighted the periapical lesions of teeth #42 (Figure 5A), #41 (Figure 5B), #31 (Figure 5C), and #32 (Figure 5D). The sagittal sections of the CBCT images indicated complete healing of the periapical lesions in teeth #32 (Figure 5H) and #42 (Figure 5E) while those in teeth #31 (Figure 5G) and #41 (Figure 5F) had significantly resolved.
case_images: Microscopic photo taken when the rubber dam isolation was completed
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case_images: PMC10896276_01_cureus-0016-00000053066-i06.jpg
case_images: FIG6
case_images: After isolating teeth #31 and #41 with a Hygenic Dental Dam (Coltene Whaledent, Altstatten, Switzerland), the pulp chambers of these teeth were examined using a DG16 endodontic probe (Hu-Friedy, Chicago, USA) under a dental operating microscope (DOM) (OPMI PICO; Carl Zeiss, Oberkochen, Germany) (Figure 6).
case_images: Microscopic photos taken during the root canal treatment procedures. (A) There was calcification (red arrow) on the pulp chamber floor of tooth #31. (B)The root canal orifice (red arrow) in tooth #31 was successfully located. (C) There was calcification (red arrow) on the pulp chamber floor of tooth #41. (D) The root canal orifice (red arrow) in tooth #41 was successfully located.
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case_images: FIG7
case_images: France), were employed. For canal negotiation, C-Pilot files (VDW, Munich, Germany) were used (Figure 7).
case_images: Post-obturation and 28-month follow-up periapical radiographs. (A) The post-obturation periapical radiograph reveals the presence of large periapical lesions in teeth #31 (yellow arrow) and #41 (red arrow). (B) A periapical radiograph taken at the 28-month follow-up shows that the periapical lesions in teeth #31 (yellow arrow)and #41 (red arrow) have significantly healed.
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case_images: PMC10896276_01_cureus-0016-00000053066-i08.jpg
case_images: FIG8
case_images: A periapical radiograph was then taken to evaluate the quality of the root canal filling (Figure 8A). Furthermore, during a follow-up phone call six years after the initial treatment, the patient reported that teeth #31 and #41 continued to be asymptomatic and functional (Figure 8B).