PMC10338130_01
Presentation of teeth #11 and #21 after one month of traumatic injury.
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One month following the traumatic injury, the patient presented with discomfort, infra-occlusion, and swelling in the buccal sulcus over the apex of tooth #21 (Figure 1).
A periapical radiograph one-month following trauma illustrating a wide-open apex on tooth #11, and evidence of resorption on two-thirds of the distal aspect (arrow). There is evidence of spontaneous apexification (arrow) on tooth #21 with a radiolucent area on the distal aspect of the root close to the apical dome.
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Radiographic examination revealed a wide-open apex on tooth #11 consistent with the patient's age, with evidence of resorption on the distal aspect of the root (Figure 2).
Posteroanterior radiograph after obturating with MTA (6 months after initial root canal treatment).
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There was a detectable barrier at a working length of 20 mm, and the entire root was obturated with MTA (Dentsply Sirona, Auckland, New Zealand; Figure 3).
Posteroanterior radiograph of tooth #21 four months after obturating with MTA.
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A periapical radiograph indicates evidence of periapical healing (Figure 4).
Photograph taken during the review appointment at 19 months after obturation with MTA showing a grey discolouration on tooth #21.
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The tooth was asymptomatic, but the crown had a grey disclouration (Figure 5).
Photograph of the dentine enamel fracture sustained by tooth #11, and the crown root fracture incurred by tooth #21.
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Photograph following decoronation of tooth #21 and root submergence.
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Periapical radiograph revealing large radiolucent area associated with the apex of tooth #21.
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A periapical radiograph revealed a large radiolucent area associated with the apex of tooth #21 (Figure 8).
Extraction of the root of tooth #21, and evidence of good marginal bone quality.
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fig9
Excellent bone quality was noted at the marginal aspect of the tooth during extraction (Figure 9), and the site healed uneventfully.
Micro-computerised tomography (CT) radiograph of the soft tissue mass and apex of tooth #21.
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A soft tissue mass was found to be attached to the apex of tooth #21 (Figure 10).
Micro-CT radiograph showing obturation with MTA.
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fig11
The obturation with MTA is demonstrated in Figure 11 with some evidence of hard tissue calcification on the distal aspect.
Micro-CT radiograph showing clinical evidence of apical calcification following the injury (red arrow).
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Further apically there is further evidence of apical calcification, which can be demonstrated in Figure 12 (shown by arrow).
Micro-CT radiograph of the apical region, in which the root face is no longer continuous Slice 3039.
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Enlarged image of Figure 13 shows the appearance of cementum-like mineralisation.
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Micro-CT radiograph illustrating the continuous calcification of the root with the formation of a dome with a central lumen lined by minerals consistent with the appearance of cementum. (a) Beginning of calcification. (b) Continous calcification. (c) Formation of the apical dome with numerous channels. (d) Final formation of a calcified Dome.
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An enlarged view of Figure 15(c) has been highlighted in Figure 16 with red arrows indicating some of the numerous channels present in the apical dome.