PMC6481130_01
Clinical photograph and periapical radiograph of this case. (a) The clinical photograph shows a violet-blue patch with a diameter of 2 mm in the buccal gingiva of tooth #20. (b) The clinical photograph shows an attrited abnormal center cusp at the center of the occlusal surface of tooth #20. (c) The periapical radiograph shows a radiolucent lesion at the periapical area of tooth #20 with a wide open apex.
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At the center of the patch, a closed sinus tract was noticed (Figure 1(a)). Abraded dens evaginatus was found in the center of the occlusal surface of tooth #20, and a fine explorer could not be inserted into the center of the fractured dens evaginatus (Figure 1(b)). An immature root with a blunderbuss apex and a periapical shadow with the size about 4 mm x 3 mm were demonstrated by X-ray radiography (Figure 1(c)).
Follow-up periapical radiographs of this case. (a) The radiograph made directly after the initial treatment shows a compact filling of Ca(OH)2 paste with working length, an open apex, and a radiolucent lesion of tooth #20. (b) The radiograph made 3 months after the initial treatment shows absorption of Ca(OH)2 paste in the canal and a slightly narrowed root apex. (c) The radiograph made after a new Ca(OH)2 paste was placed. (d) 7 months after the initial treatment shows healing of the periapical bone, more reduction of the root canal space, and a significant root-end barrier. (e) The radiograph made after the root canal was filled with gutta-percha shows a significant root-end barrier and a compact filling. (f) The clinical photograph taken 2 years after the treatment was finished shows a sound tooth #20 without discoloration and disappearance of the patch in the buccal gingiva of tooth #20.
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Glass-ionomer cement was used to seal the access (Figure 2(a)). The X-ray examination showed Ca(OH)2 absorption in the canal (Figure 2(b)). After removing the Ca(OH)2 paste by 0.9% saline, a thin hard barrier was detected, while an open apex was still detectable by X-ray in the treated tooth (Figure 2(c)). Seven months after the first Ca(OH)2 treatment (four months after the second treatment), periapical radiography demonstrated the absorption of Ca(OH)2 paste, significantly narrowed root canal, obviously established root-end barrier, and progressively healed periapical bone with minor radiolucency around the apex (Figure 2(d)). Then, the canal was washed, dried, and filled with gutta-percha (Figure 2(e)). An intraoral examination done two years after the composite resin sealing showed tooth #20 without discoloration and disappearance of the patch in the buccal gingiva (Figure 2(f)).