PMC7757942_01
a, b. Clinical appearance before treatment, (a) frontal view of the patient at intake, note the irritative dermatitis, (b) sagittal view showing the sessile base of the red nodule
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F1
The main complaint was a shiny smooth nodule on her chin that had been present for almost a year (Figure 1a, b).
a, b. Histological findings of the removed lesion by the dermatologist showing granulation tissue. (a) Overview, (b) higher magnification showing several blood vessels embedded in a loose connective tissue containing fibroblasts and inflammatory cells (Haematoxylin and eosin stain)
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F2
Based on the histological examination of an earlier lesion removed by the dermatologist, the diagnosis of exuberant granulation tissue was made (Figure 2a, b).
a-f. Clinical changes of the granulation tissue, (a) at intake, (b) detail of the granulation tissue, (c) endodontic treatment and a corticosteroid ointment made the granulation tissue shrink, (d) some purulent exudate was still visible 3 months after endodontic treatment, and an antibiotic treatment was prescribed, (e) clinical picture 10 days after the use of antibiotics, (f) after 1 year, a small discrete scar remained
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F3
During extraoral inspection, a red lobulated exophytic lesion could be seen at the left of her chin (Figure 3a). Closer examination using the dental microscope (Opmi Pico, Carl Zeiss, Oberkochen, Germany) revealed a highly vascular tissue of approximately 0.8 inches in width (Figure 3b). One month later, the granulation tissue was reduced in size (Figure 3c). Three months later, periapical radiography showed no clear signs of healing (Figure 4d), a purulent exudate was visible (Figure 3d) and the sinus tract could still be explored with a gutta percha cone (Video 00:49-00:58, See Page: https://doi.org/10.5152/eej.2017.17007). Only a small scar at the left of her chin could be noticed (Figure 3e). Extraoral inspection revealed the presence of a discrete scar (Figure 3f) (Video 00:59-01:30, See Page: https://doi.org/10.5152/eej.2017.17007).
a-f. Periapical radiographs showing the changes of the granuloma. (a) At intake, periapical radiolucency was visible, (b) Ca(OH)2 paste as an interappointment dressing, (c) endodontic treatment, (d) three months follow up showed no signs of healing, (e) six months follow up showed ongoing bone healing, (f) one year follow up showed healing of the periapical tissues
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F4
Periapical radiography showed a periapical lesion associated with tooth 32 (Figure 4a). The tooth was endodontically treated following the quality guidelines for endodontic treatment as described in the consensus report of the European Society of Endodontology (Figure 4b, c). Three months later, periapical radiography showed no clear signs of healing (Figure 4d), a purulent exudate was visible (Figure 3d) and the sinus tract could still be explored with a gutta percha cone (Video 00:49-00:58, See Page: https://doi.org/10.5152/eej.2017.17007). Periapical radiography showed ongoing healing after 6 months and full healing after 1 year (Figure 4e, f).
a-f. CBCT findings, (a) cross-sectional image showing destruction and expansion of the cortical bone, (b) sagittal image of tooth 32, (c) three-dimensional reconstruction, Note the root tip of tooth 32 through the destructed bone, (d) cross-sectional image one year after endodontic treatment showing a closed cortex and new trabecular bone around the root tip, (e) sagittal image after endodontic treatment, (f) three-dimensional reconstruction showed healing of the cortical bone. CBCT: cone-beam computed tomography
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F5
Morita MFG Corp, Kyoto, Japan) was acquired to assess the extensiveness of the lesion in three dimensions (Figure 5a-c). Bone healing could be seen in all three dimensions, and the cortical disruption was closed (Figure 5d-f).
a, b. Clinical appearance after treatment, (a) frontal view of the patient, only a discrete scar remained 1 year after treatment, (b) sagittal view 1 year after treatment
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F6
However, the patient had no complaints and was satisfied with the healing so no further aesthetic treatments were planned (Figure 6a, b).