PMC8154279_01
Intraoral picture of lesion in buccal vestibule of the mandibular left side.
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fig1
Intraoral preoperative periapical radiograph showing an irregular periapical radiolucency involving both #33 and #34. (a) Tracing was made using gutta-percha point done. (b, c) Other periapical angles.
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fig2
These finding were more investigated through radiographical examination, an orthopantomogram (OPG) (Figure 3) and periapical radiograph for tooth #34 (Figure 2) were taken.
Orthopantomogram showing multiple missing teeth and endodontic treatment of tooth #34.
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fig3
These finding were more investigated through radiographical examination, an orthopantomogram (OPG) (Figure 3) and periapical radiograph for tooth #34 (Figure 2) were taken.
(a, b) Intraoral photograph after bone removal. (c) Necrotic bony trabeculae with actinomycosis filaments on the trabecular surface (black circle) and extensive sclerosis of bone showing prominent resting and reversal lines (**).
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fig4
In addition, trabecular surface and bone sequestrum of the necrotic bone were showing actinomycosis colonies (Figure 4).
H&E stain showing bacterial invasion in the bone causing resorption. Bacteria (black arrow) and resorption of bone (black stars).
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fig5
Postoperative periapical radiograph showing endodontic treatment of both teeth #33 and #34.
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fig6
Obturation of the remaining canal with gutta-percha and AH 26 sealer, with continuous wave compaction, temporized with cavit and silver glass ionomer (Ketac) as temporary (Figure 6). Tooth #33, a conventional RCT, carried out following the same steps of tooth #34 but obturation was made using gutta-percha and AH 26 sealer (Figure 6), and then the tooth was restored with temporary filling.
1-year recall periapical radiograph showing healing of the lesion.
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fig7
The patient was followed up at six months and one year period with no evidence of lesion recurrence (Figure 7).