PMC10235735_01
(a) Preoperative Clinical image showing sinus opening, (b) Pre-operative IOPA with mixed radiolucency and radiodensities, (c) CBCT showing full extent of the lesion
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On clinical examination, sinus opening was seen in gingival sulcus wrt #11 and #12 and during probing, hard base was felt wrt sinus opening [Figure 1(a)]. Root canal treatment of #11, #12 and #13 was observed, with over-obturation in #12 and root resorption in #11 [Figure 1(b)]. Lesion measured 15.6 x 8.5 x 12.7 mm (TRXAPXCC) in greatest diameters with cortical bone erosion, giving PAI score of 5D [Figure 1(c)].
(a) Trapezoidal flap elevated, (b) granulation tissue removal done, (c) Apicoectomy done and root end preparation completed using diamond ultrasonic tips (Woodpecker,) wrt #12, (d) end cavity restored using Biodentine wrt#12, (e) Root perforation repaired using Biodentine#11, (f) Bony cavity filled with sticky bone, (g) Flap repositioned and sutured using 4-0 silk suture, (h) post-Operative IOPA, (i) calcified structures removed from the lesion, (j, k) Histopathology of calcified structures
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A full thickness trapezoidal mucoperiosteal flap extending between #13 and #21 was elevated using periosteal elevator [Figure 2(a)]. The cavity was thoroughly irrigated using normal saline [Figure 2(b)]. Apicoectomy was performed in #12, and end cavity was restored using biodentine [Figure 2(c, d)]. The resorbed root of #11 was restored using biodentine [Figure 2(e)]. Hydroxyapatite granules (GGG1, Surgiwear) were mixed with iPRF forming a fibrin bone graft (sticky Bone) [Figure 2(f)]. The flap was repositioned and sutured using 3-0 silk suture [Figure 2(g)]. Post-operative IOPA was taken to evaluate treatment performed [Figure 2(h)]. The capsule and calcified structures removed from the lesion were preserved in 10% formalin and sent for histopathology [Figure 2(i)]. Histologic examination revealed the presence of conglomerate of mature tubular dentine [Figure 2(j)]. Thin layer of cementum was also seen at the periphery of the mass [Figure 2(k)].
(a) Dehiscence after surgery, (b) Dehiscence after second surgery, (c) Iodoform dressing for healing by 20 Intension, (d) 3 months post-operative healing, (e) 6 months post-operative, (f) 9 months post-operative clinical, (g) 9 months post-operative IOPA, (h) 12 months post-operative clinical, (i) 12 month post-operative IOPA
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After 1 week, patient reported with dehiscence of the surgical site [Figure 3(a)]. Again, after 1 week, patient developed dehiscence at the surgical site [Figure 3(b)]. Patient was given iodoform dressing for 4 weeks in every 2-day interval [Figure 3(c)]. Patient showed signs of healing after 3 and 6 months [Figure 3(d), (e)]. After 9 months, complete healing was observed [Figure 3(f),(g)]. Patient was recalled at 12 months, which showed excellent healing with no signs of recurrence [Figure 3(h), (i)].