PMC5818892_01
Endobuccal examination: mucosa fistula.
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Intraoral examination revealed enamel-dentin fracture involving the incisal edge in tooth #11, in the upper right lateral incisor region (Figure 1).
Radio using locating cone showing the relationship with tooth 12. Teeth 11 and 21 were both endodontically treated.
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Radiographic evaluation was performed using a film holder which showed the relationship with tooth #12; both central incisors were endodontically treated (Figure 2).
Root canal filling of tooth 12.
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Endodontic treatment of tooth #12 was planned (Figure 3).
Fistula recurrence after 2 years involving tooth 12, persistence of periapical lesion.
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A periapical radiograph with film holder has built evidence to show the relation with tooth #12 (Figure 4).
Presence of granulation tissue on the periapical side of tooth 12.
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Periapical surgery was carried out and revealed a proliferation of granulation tissue around the apex of the lateral incisor (Figure 5). Periapical curettage followed by a 3 mm root-end resection of tooth #12 (Figure 6) was conducted.
Apical root resection.
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Periapical surgery was carried out and revealed a proliferation of granulation tissue around the apex of the lateral incisor (Figure 5). Periapical curettage followed by a 3 mm root-end resection of tooth #12 (Figure 6) was conducted.
Radiological control after root end filling: excess glass ionomer cement.
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The radiological control after root-end filling showed cement excess (Figure 7).
Fistula recurrence after 3 weeks. Locating cone showed relation between tooth 12 and tooth 11.
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The reappearance of the sinus tract was actually surprising; a periapical radiograph using gutta-percha cones, after fitting them to a gauged apex, showed a relation between both right lateral and central incisors (Figure 8).
Second surgical exploration showing vertical root fracture in the palatal side of tooth 11.
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A second exploratory surgery at routine six-month recall was decided with palatal and buccal full-thickness flaps elevation, revealing the undiagnosed VRF on the palatal side of tooth #11(Figure 9).
Sealing of the vertical root fracture with fluid resin composite.
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The fracture line was sealed using a fluid composite resin (Figure 10).
Radiograph of control after 1 month.
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Clinical and radiographic evaluation was performed after one month (Figure 11), then three months later (Figure 12), and at one-year follow-up (Figure 13).
Radiograph of control after 3 months.
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Clinical and radiographic evaluation was performed after one month (Figure 11), then three months later (Figure 12), and at one-year follow-up (Figure 13).
Radiograph of control 1 year later.
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Clinical and radiographic evaluation was performed after one month (Figure 11), then three months later (Figure 12), and at one-year follow-up (Figure 13).
Radiograph of control 3 years later.
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After three years (Figure 14), the healing of tooth #11 was evident with a probing depth anda mobility ranging within normal physiological limits.