PMC4283423_01
Clinical intraoral photographs. (a) Gingival swelling over the buccal region of tooth 30 (see the dark arrow) and healthy gum of tooth 29. (b) A 10-mm pocket in the buccal furcation of tooth 30 at the initial visit. (c) A 4-mm furcal pocket of tooth 30 in three-month follow-up after operation. (d) At 7-month recall, the furcal probing depth of tooth 30 lessened to about 2 mm.
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Clinical examination revealed obvious gingival swelling over the buccal region of tooth 46 (Figure 1(a)). The probing depths for all sites in the dentition did not exceed 3 mm except for a 10-mm pocket in the buccal furcation of tooth 46 (Figure 1(b)). At 3 months, oral examination revealed good healing of soft tissues and the furcal probing depth of tooth 46 had lessened to 4 mm (Figure 1(c)). At 7 months, the soft tissues were in healthy condition and the furcal probing depth of tooth 46 was about 2 mm (Figure 1(d)).
Radiographs. (a) Radiograph at the initial visit showing a large periapical lesion associated with tooth 45, measuring 14 x 15 mm in diameter. (b) A periapical radiograph of tooth 29 and tooth 30 to observe and record the immediate postoperative situation. (c) Radiograph after 3 months showing a decrease in the size of the periapical radiolucency to 13 x 14 mm in diameter and some material implanted seemed to be absorbed. (d) Radiograph after 7 months showing an apparent decrease in the size of the radiolucent area to 4 x 5 mm in diameter.
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The radiograph showed a well-defined round radiolucent lesion approximately 14 x 15 mm in diameter surrounded by a radiopaque line, around the root apex of tooth 45 and with a radiopaque margin involving the apical third of the mesial root of tooth 46 (Figure 2(a)). A small area of radiolucency was also present in the furcation of tooth 46 (Figure 2(a)). A periapical radiograph of teeth 45 and 46 was taken to observe and record the immediate postoperative situation (Figure 2(b)). A radiograph revealed a decrease in the size of the periapical radiolucency to 13 x 14 mm in diameter and some material implanted seemed to be absorbed (Figure 2(c)). A radiograph showed an apparent decrease in the size of the radiolucent area to 4 x 5 mm in diameter (Figure 2(d)).
Intraoperative photographs. (a) Osseous destruction region did not involve the root apex of tooth 30. (b) Osseous destruction region around the root apex of tooth 29 penetrated through periodontal ligament of the mesial root and involved the furcation area of tooth 30. (c) Osseous destruction region was filled with Bio-Oss Collagen.
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Further inspection found that the osseous destruction around the root apex of tooth 45 penetrated through periodontal ligament of the mesial root and involved the furcation area of tooth 46 (Figures 3(a) and 3(b)). After the surgical region was rinsed with normal saline, the bony wall of the cavity was scratched until it was filled with blood, and then Bio-Oss Collagen was placed into the bony destruction of teeth 45 and 46 (Figure 3(c)), as has been previously suggested.