PMC4244928_01
The initial radiograph showing the radiopaque body invading the periapical tissues.
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The radiographic inspection revealed the presence of an intraradicular post at the crown level, which was surrounded until the middle third of the root by sealing material (Figure 1).
(a) The clinical appearance of the metal fragment located in the periapical tissues. (b) An image showing the length (approximately 10 mm) of the metal foreign body that was removed during the surgical procedure.
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After locating and exposing the periapical lesion, all tissue within the bony crypt was removed with a curette to locate the foreign body (metal fragment) (Figure 2(a)), which was easily removed with a hemostat (Figure 2(b)).
Clinical appearance of the surgical socket after the removal of the metal fragment.
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Because the tooth had an incomplete root formation, once the bleeding was under control with the use of gauze impregnated with ferric sulphate, the root apex was remodeled only slightly with a Zekrya bur at high speed (Figure 3).
A postoperative radiograph shows the proper retrograde placement of thermoplasticized gutta-percha in direct contact with the resin located inside the main canal.
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Texas, USA), which was compacted and its placement was confirmed radiographically once it had cooled (Figure 4). The flap was approximated and sutured gently with 5-0 nylon separate stitches.
A follow-up radiograph at 12 months reveals a marked decrease of the periapical lesion, which was in the process of healing.
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It was decided to change the crown restoration to prevent the coronal leakage of saliva; however, the patient returned for a follow-up after 12 months, at which time proper radiographic healing of the periapical lesion was observed, and no symptoms or signs of infection were found (Figure 5) and clinically there was no clinical coronal leakage.
A follow-up radiograph at 52 months (4 years and 4 months) reveals complete healing of the initial periapical bone defect. At this time, the case was considered to be healed.
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Probing depth and tooth mobility were again within normal limits, and radiographs revealed adequate periapical healing (Figure 6).