PMC4686639_01
Occlusal tubercle in the mandibular premolars.
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The patient was concerned about the "bubble on her gums." On examination patient had fair oral hygiene and occlusal tubercle present in mandibular premolars (Figure 1).
Diagnostic IOPAR, periapical radiolucency with respect to 44.
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Intraoral Periapical Radiograph (IOPAR) revealed periapical radiolucency with respect to 44 (Figure 2).
After access opening. Dens evaginatus in right and left premolars.
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Root canal therapy (RCT) of tooth 44 and adjustment of occlusal tubercle of teeth 34, 35, and 45 were planned (Figure 3).
Placement of calcium hydroxide (Metapex) intracanal medication.
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Microbiological culture showing gram positive cocci in clusters and in pair and short chains.
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In the culture media growth of Enterococcus faecalis and Streptococcus species was observed (Figure 5).
Culture and sensitivity test: triple antibiotic paste with largest inhibition zone in upper left region.
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The triple antibiotic paste was seen to have the largest inhibition zone (Figure 6).
Obturation with gutta-percha and endodontic sealer.
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The tooth was obturated with gutta-percha points (Dentsply, Maillefer) using AH Plus (Dentsply, Konstanz, Germany) root canal sealer followed by restoration with composite resin (Figure 7).
Six-month follow-up.
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Follow-up evaluation after six months revealed progressive healing of the lesion (Figure 8).