PMC10098410_01
Mandibular left second molar with symptomatic apical periodontitis. (a) Pre-operative radiograph showing inadequate previous root canal treatment and a large periapical lesion. (b) After removal of the root canal obturation materials, canal preparation, and insertion of antibiotics. (c) Follow-up radiograph after 4 months and relative healing of the periapical lesion. (d) Post-operative radiograph 12 months after the initial radiograph, the obturated canals and bone healing. (e) Post-operative radiograph after 3 years from the initial radiograph, complete bone healing and thorough disappearance of the lesion.
CRID2023-6889019.001.jpg
PMC10098410_01_CRID2023-6889019.001.jpg
fig1
The mesial/distal roots and bone in the distal aspect of the tooth seemed to have resorbed (Figure 1(a)). Then, the tooth was temporarily dressed with Zonalin  (i.e., re-enforced zinc oxide eugenol; Kemdent, Swindon, UK), and the patient was dismissed for regular clinical observations (Figure 1(b)). In the radiographic evaluation, relative healing of the surrounding bone and disappearance of the periapical lesion were seen (Figure 1(c)). Iran), via mixing its liquid and powder in accordance with the manufacturer's instructions, and the tooth was coronally restored using amalgam (Cinalux Faghihi, Tehran, Iran) as the restorative material in the same session (Figure 1(d)). In 3-year follow-up, thorough healing of the bone and complete disappearance of the periapical lesion were radiographically observed (Figure 1(e)).
PMC10098410_02
Mandibular left first molar with symptomatic apical periodontitis. (a) Pre-operative radiograph showing inadequate previous root canal treatment, broken instruments, and a large periapical lesion around the mesial root. (b) After removal of the root canal obturation materials, canal preparation, and application of intracanal medication. (c) Follow-up radiograph after 4 months and relative healing of the periapical lesion. (d) Post-operative radiograph 9 months after the initial radiograph, the bone healing and canal obturation. (e) Post-operative radiograph 17 months from the initial radiograph. (f) 28-month follow-up radiograph exhibiting complete bone healing and disappearance of the lesion.
CRID2023-6889019.002.jpg
PMC10098410_02_CRID2023-6889019.002.jpg
fig2
Moreover, inadequate root canal obturation was seen in the mesial and distal canals, with a small radiographic lesion surrounding the distal root (Figure 2(a)). Next, the tooth was permanently restored with dental amalgam (Cinalux Faghihi), and the patient was dismissed for regular postoperative sessions (Figure 2(b)). Therefore, the restoration was removed, the canals were irrigated, PMC was re-applied into the canals, the tooth was restored, and the patient was dismissed for the next appointment (Figure 2(c)). The tooth was restored with amalgam (Cinalux Faghihi), and the patient was dismissed for another follow-up session (Figure 2(d)). In a 16-month follow-up, complete healing of the bone around the distal root was observed, whereas the periapical lesion around the mesial root had become much smaller in comparison with the initial diagnostic radiograph (Figure 2(e)). The patient reported no complaint regarding swelling and pain on percussion (Figure 2(f)).
PMC10098410_03
A mandibular right first molar with symptomatic apical periodontitis. (a) Diagnostic periapical radiography showing compromised previous endodontic treatment and a large periapical radiolucency around the mesial root. (b) In-treatment periapical radiography demonstrating conservative preparation of access cavity, removal of obturation materials, and proper cleaning and shaping of the mesial canals. (c) Immediate post-treatment radiography, revealing periapical lesion regression with clinical disappearance of pain and relative healing of the regional swelling. (d) Post-operative radiograph after 10 months of the initial treatment, exhibiting bone healing and progressive disappearance of the large periapical radiolucency.
CRID2023-6889019.003.jpg
PMC10098410_03_CRID2023-6889019.003.jpg
fig3
Radiographic evaluation revealed an inappropriate previous endodontic treatment in the mesial canals as well as a large periapical radiolucency surrounding the mesial-root periapical region with bone resorption evident in the area; nevertheless, the endodontic treatment conducted in the distal root, post insertion, and the crown restoration seemed to be satisfactory (Figure 3(a)). Next, PMC was prepared (same formulation as Case 1) and transferred to the mesial canals, and tooth #30 was temporised with Zonalin  (Kemdent; Figure 3(b)). Successively, the tooth was restored permanently with resin-based dental composite restorative material (3M  Filtek  Z250, USA), and the patient was dismissed (Figure 3(c)). After 6 months of the final restoration and 10 months of the initial treatment, the tooth remained completely functional and asymptomatic with perfect bone healing and considerable disappearance of the periapical lesions (Figure 3(d)).