PMC3626358_01
(a) Preoperative photo showing crown fracture and discoloration in left maxillary lateral incisor. (b) IOPA radiograph showing well-defined radiolucency and open apex. (c) Working length IOPA radiograph. (d) IOPA radiograph showing MTA obturation. (e) Coronal plane CBCT image showing size of periapical lesion immediately after MTA obturation. (f) Coronal plane CBCT image showing size of periapical lesion; dimensions 9.8 mm/7.5 mm. (g) Sagittal plane CBCT image showing size of periapical lesion immediately after MTA obturation. (h) Axial plane CBCT image showing size of periapical lesion immediately after MTA obturation. (i) Sagittal plane CBCT image showing size of periapical lesion immediately after endodontic treatment in tooth 21. (j) Three-dimensional CBCT image of periapical lesion immediately after MTA obturation. (k) Sagittal plane CBCT image showing status of MTA obturation. (l) Axial plane CBCT image showing status of MTA obturation.
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On clinical examination, Ellis class 2 fracture was noted in teeth 21 and 22 (Figure 1(a)). Radiographic examination with IOPA radiograph revealed a well-defined radiolucency with respect to the apex of both teeth and a wide open apex in tooth 22 (Figure 1(b)). First, access opening was done, followed by working length determination (Figure 1(c)). A plugger was used to condense MTA homogeneously into the canal (Figure 1(d)). CBCT examination was done immediately after MTA obturation (Figures 1(e)-1(l)) using limited field of view CBCT unit (9000 3D, KODAK, USA).
(a) Build-up with composite and tooth preparation. (b) Temporization with acrylic crowns. (c) Permanent cementation of PFM crowns.
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The composite core build-up and tooth preparation was done on both teeth for ceramic crowns in the next appointment (Figure 2(a)). Temporization was done with acrylic crowns (Figure 2(b)). The permanent crowns, that is, porcelain fused-to-metal (PFM) crowns, were cemented on both teeth six months after the endodontic treatment and followup with CBCT (Figure 2(c)).
(a) IOPA radiograph at one month. (b) IOPA radiograph at three months. (c) IOPA radiograph at six months. (d) IOPA radiograph at one year. (e) IOPA radiograph at two-year followup. (f) Coronal plane CBCT image showing decreased size of periapical lesion at six months. (g) Coronal plane CBCT image showing measurement of periapical lesion; dimensions 5.7 mm/3.9 mm. (h) Sagittal plane CBCT image showing decrease in size of periapical lesion at six months. (i) Axial plane CBCT image showing decrease in size of periapical lesion at six months. (j) Three-dimensional CBCT image showing periapical lesion six months. (k) Sagittal plane CBCT image showing status of MTA obturation at six months. (l) Axial plane CBCT image showing status of root-canal filling at six months.
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The IOPA radiographic evaluation revealed a decreasing size of the periapical radiolucency at each visit after one month, three months, six months, one year, and two years (Figures 3(a)-3(e)). The second CBCT evaluation done after six months revealed a decrease in the size of periapical radiolucency in all the three planes:coronal, sagittal, and axial and in three-dimensional reconstruction images (Figures 3(f)-3(j)). The status of MTA obturation as evaluated with CBCT revealed a well compacted filling up to the apex with no voids, even after six months (Figures 3(k)-3(l)).