PMC9635965_01
Preoperative clinical condition.
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In the same area, the presence of bleeding on probing (Figures 1 and 2) indicated a relevant gingival inflammation.
Bleeding on probing exam.
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In the same area, the presence of bleeding on probing (Figures 1 and 2) indicated a relevant gingival inflammation.
(a) Preoperative periapical X-ray and (b) preoperative CBCT.
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To confirm suspicion of EICR, a radiographic examination was also realized; first of all, a periapical radiograph was performed and showed the presence of a radiolucent lesion in the coronal third of the root of 1.1, in its distal portion (Figure 3(a)). CBCT imaging was essential to assess the stage of the lesion and which structures were compromised (Figure 3(b)). 3D images revealed that the lesion had already penetrated close to the coronal pulp, but it appears that there was no communication. Considering the clinical and radiological findings, the resorptive defect was classified as a Heithersay class II.
Phases of surgery: (a) defect exposition by surgical flap, (b) isolation by liquid rubber dam, (c) composite restoration of the defect, and (d) repositioning and suture of the flap.
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After administering local anesthesia (articaine 4% with epinephrine 1 : 100,000, Pierrel, Capua, Italy), a full thickness flap was performed (Figure 4(a)). Once hemostasis was managed, isolation with a liquid rubber dam was obtained (Figure 4(b))), and common steps were followed for composite restoration. Paul, MN, USA), and the restoration was accurately finished and polished (Figure 4(c))). Inc., Johnson & Johnson Company, Somerville, NJ, USA; Figure 4(d)). Ice application was recommended, and a twice-daily oral rinse with 0.20% chlorhexidine was prescribed during the 7 days after surgery.
(a) Necrotic pulp tissue and (b) rubber dam isolation.
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Dental Continental S.A. De C.V., Zapopan, Mexico) isolation was placed (Figure 5(b)) with a 9 clamp (Ivory , Kulzer Nordic AB, Helsingborg, Sweden) fixed on tooth 1.1. In Figure 5(a), it is possible to appreciate the characteristic grey color of a necrotic pulp tissue.
Postoperative X-ray of root canal treatment.
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Postoperative X-ray was performed (Figure 6).
Phases of class V restoration: (a) rubber dam isolation, (b) enamel total acid etching, (c) bonding agent application, and (d) final restoration results.
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Rubber dam isolation was placed with No. 9 clamp on tooth 1.1 and No. 0 clamp on tooth 2.5 (Figure 7(a)). The old resin restoration was removed, and total acid etching was performed for 20 seconds (Figure 7(b)). Then, a two-step bonding system (Scotchbond Universal Adhesive, 3M Company) was applied to the cavity (Figure 7(c)). The cavity was filled with resin composite (Filtek Z500, 3M Company), and finally, the restoration was polished and finished (Figure 7(d)).
X-ray at (a) 1-year, (b) 2-year, and (c) 3-year follow-ups.
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(a) Probing and postoperative clinical condition and (b) X-ray at the 6-year follow-up.
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