PMC7604462_01
(A) Intraoral view of the upper right quadrant at baseline; calculus and gum bleeding is visible. (B) Intraoral view of the frontal lower teeth at baseline; small amounts of calculus and pus discharge are visible.
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Clinical examination revealed pus discharge (Figure 1A and B) and gingival swelling, 82.2% of the sites had a probing depth (PD) of >=4 mm, and 87% of the sites had bleeding on probing.
Panoramic radiograph at baseline.
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Panoramic radiographs were obtained and revealed horizontal and vertical alveolar bone resorption (Figure 2).
(A) Upper right quadrant after antibiotic therapy. (B) Frontal lower teeth after antibiotic therapy.
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There was no pus discharge after antibiotic therapy (Figure 3A and B).
Intraoral view of the frontal lower teeth 14 days after SRP and splinting.
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Follow-up 2 weeks after RSP showed no pus or bleeding on probing (Figure 4).
Intraoral view 6 months after SRP.
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No pus discharge or bleeding on probing was observed at a 6-month follow-up appointment (Figure 5).
Panoramic radiograph 6 months after SRP: tooth #43 showed an extensive periapical lesion with well-defined borders and bone loss extruding onto the root's mesial surface.
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Panoramic radiographs (Figure 6) revealed that the alveolar bone level was considered stable compared with previous radiographs.
"Walking" probing of the periodontal pocket using a Naber periodontal probe. Distal buccal point (A), middle buccal point (B), mesial buccal point (C), all measurements are 2 mm probing depth. (D) Narrow and deep 8 mm periodontal pocket on the mesial tooth surface.
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All of the measurements were 2 mm, except for the mesial side, where a narrow 8 mm periodontal pocket and 10 mm of clinical attachment loss was revealed (Figure 7A-D).
(A) No bleeding was observed immediately after endodontic access opening. (B) Instrumentation of the root canal using an iRace rotary endodontic instrument. (C) Passive ultrasound irrigation with an ultrasound tip. (D) Treating the root canal with ozone gas.
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The patient was referred to an endodontist and underwent endodontic treatment (Figure 8A-D) according to the following protocol: administration of local anesthesia using 1.7 mL of 4% articaine (Ubistesin Forte, 3M ESPE), rubber dam isolation, and preparation of endodontic access.
(A) Working length confirmation. (B) Immediately after obturation. (C) Six-month follow-up showing complete healing of the bone defect in the periapical area and interdental septum.
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Necrotic pulp was found, and the working length was confirmed with radiographs (Figure 9A). Obturation was controlled with radiographs (Figure 9B). The patient returned for a follow-up appointment 6 months after endodontic treatment Periapical radiograph demonstrated complete healing of the periapical lesion and reorganization of the alveolar bone lateral to the tooth surface (Figure 9C).
Prozone ozone generator.
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The root canal was dried and treated with ozone gas from an ozone generator (Prozone, W&H) for 24 seconds following endodontic setting in Prozone (Figure 10).