PMC5282392_01
A) First visit occlusal view; B) After 6-month placement of calcium hydroxide; C) After 20 months of calcium hydroxide placement
iej-12-116-g001.jpg
PMC5282392_01_iej-12-116-g001.jpg
F1
Findings from periapical and occlusal radiographies and cone-beam computed tomography (CBCT) showed an extensive periapical radiolucency around the apex of the maxillary right central incisor, pulp canal space was wide and the tooth had an intact crown (Figure 1).
A) Pretreatment periapical view; B) Working radiography; C) Application of calcium hydroxide; D) After 6 months of calcium hydroxide therapy; E) Post treatment radiography; F) Follow-up radiography after 20 months
iej-12-116-g002.jpg
PMC5282392_01_iej-12-116-g002.jpg
F2
After radiographic determination of the working length, cleaning and shaping of the canal was done with rotary instruments (step-down technique using RaCe rotary files, FKG Dentaire, La-Chaux-de Fonds, Switzerland) and irrigation with 5.25 % NaOCl (Figure 2A and B). These radiographies showed significant shrinkage in the lesion size (Figure 2D). Then the canal was obturated using lateral condensation of gutta-percha points (Dentsply Maillefer, Ballaigues, Switzerland) and AH-26 as sealer (Dentsply, De Trey, Konstanz, Germany) (Figure 2 E).  After a 20-month follow-up, the patient was asymptomatic and there was no sign of periapical pathology and significant bone formation was seen at the periapical region on periodic follow-up radiographies (Figure 2F).
CBCT view; A) first visit; B) after 6 months, Significant shrinkage in the size of the lesion was observed; C) After 20 months of follow-up
iej-12-116-g003.jpg
PMC5282392_01_iej-12-116-g003.jpg
F3
Complete radiographic and clinical healing of the periapical lesion was observed (Figure 3).