PMC9871415_01
Periapical radiographs and cone-beam computed tomographic (CBCT) images of case #1: (A) Initial periapical radiography, showing a large endodontic lesion, severe bone destruction, and poor obturation in mesial root. (B) CBCT images in the coronal, axial, and sagittal plans, indicating a large periradicular lesion around the mesial root resorbing the buccal plate, missing the second mesiobuccal canal, and signs of external inflammatory root resorption [EIRR]. (C) Removal of previous endodontic filling materials, chemomechanical preparation of root canals, application of intracanal medication using penicillin G, metronidazole, ciprofloxacin [PMC], and temporization of coronal cavity. (D) 3-month recall, demonstrating relative resolution of large periradicular lesion around the mesiobuccal root. (E) Obturation of root canals and restoration of coronal cavity with resin-based dental composite restorative material. (F) 26-month recall, revealing perfect bone healing, thorough disappearance of periapical lesion, and complete arrest of EIRR.
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Additionally, the closer observation of previous endodontic treatment indicated underfilling in the mesiobuccal root (Figure 1A). Cone-beam computed tomography (CBCT) showed missed second mesiobuccal canal (MB2), poor obturation, large bone destruction, and signs of the external inflammatory resorption of mesial root (Figure 1B). After irrigation with normal saline solution, PMC (penicillin G, metronidazole, and ciprofloxacin with the ratio of 1:1:1) was prepared and transferred into the RCS with the succeeding temporization of coronal cavity (Figure 1C). A week later, the abscess completely subsided and the patient reported no pain on percussion/mastication, and in 3 months, radiographic evaluation revealed the relative resolution of large periradicular radiolucency (Figure 1D). Subsequently, the RCS was cleaned with copious amounts of normal saline, obturated with gutta-percha/sealer using lateral condensation technique, and the coronal cavity was restored with resin-based dental composite restorative material (Figure 1E), and the patient was dismissed for regular follow-ups. Radiographic examination showed complete healing of the large endodontic lesion, normal bone architecture, and re-establishment of periodontal ligament (PDL; Figure 1F).
PMC9871415_02
Periapical radiographs of case #2: (A) Initial diagnostic periapical radiography, exhibiting defected coronal restoration, inappropriate previous endodontic treatment, and negotiated bifurcation with large regional radiolucency. (B) Removal of compromised coronal restoration materials, cleaning the pulp chamber, detection of bifurcation involvement, and employment of the novel combination of triple antibiotics [PMC] and temporization of coronal cavity. (C) Repair of furcation perforation using calcium-enriched mixture cement after the abscess has totally been subsided and re-employment of the PMC. (D) 3-month recall; revelation of the relative resolution of bifurcation radiolucency. (E) 4-month recall; mere disappearance of bifurcation radiolucency, chemomechanical preparation/obturation of root canals with gutta-perch/sealer and restoration of coronal cavity with resin-based dental composite restorative material. (F) 10-month follow-up; expressing complete resolution of bifurcation lesion, and regional bone healing.
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In diagnostic radiography evaluation, poor coronal/root canal filling and bifurcation radiolucency were seen; the furcation seemed to have been negotiated and perforated during the previous treatment (Figure 2A). The compromised coronal restoration was completely removed, the furcation perforation was instantly located, PMC was prepared (in accordance with the protocol mentioned in case 1) and was transferred to the access cavity, the coronal cavity was finally temporized, and patient was dismissed for 2 weeks (Figure 2B). In 10-day recall, the abscess totally subsided and the patient reported no pain/discomfort on chewing; thereafter, old PMC was removed, perforated furcation was repaired/sealed with a calcium silicate-based bioactive [i.e., calcium-enriched mixture (CEM)] cement, fresh PMC was re-employed into RCS, and the tooth was temporized (Figure 2C). Three months later, radiographic examination demonstrated a relative resolution of the furcation lesion (Figure 2D). Consecutively, the coronal cavity was restored with resin-based dental composite restorative material (Figure 2E). In 10-month recall, the patient reported no clinical symptoms/discomfort and radiographic evaluation showed favorable outcomes, that is, the complete disappearance of furcation lesion and perfectly new regional bone formation (Figure 2F).
PMC9871415_03
Periapical radiographs of case #3: (A) Preliminary diagnostic periapical radiography; a large periapical lesion and shortened roots caused by external inflammatory root resorption [EIRR] are evident. (B) Previous restorative/endodontic filling materials were removed, PMC was employed and tooth #31 was temporized. (C) 2-week recall; after the clinical sign/symptoms has totally been subsided, chemomechanical preparation was performed, root canals were filled with a calcium silicate-based biomaterial, that is, CEM cement, and coronal cavity was restored using a resin-based dental composite restorative material. (D) 30-month recall; perfect healing of the periradicular lesion/bone healing and thorough arrest of EIRR are clearly observed.
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In initial periapical radiography, it was shown that the tooth had been previously treated endodontically; however, a large periradicular lesion wrapped around both roots and external inflammatory root resorption (EIRR) had shortened the roots (Figure 3A). The tooth was temporized, and the patient was dismissed for 2 weeks (Figure 3B). Consequently, the coronal dressing and PMC were removed, and following irrigation/drying out, canals were chemomechanically prepared and then obturated using a calcium silicate-based biomaterial, that is, CEM cement, and the coronal cavity was filled with resin-based dental composite restorative material (Figure 3C). In addition, radiographic evaluation revealed perfect healing of the lesion and thorough arrest of EIRR (Figure 3D).