PMC6877977_01
(a) Clinical photograph of tooth #6 after the removal of provisional FPD, normal clinical appearance. (b) Clinical photograph of tooth #11 after the removal of provisional FPD, red hue appearance. (c) Radiograph of tooth #6 before the removal of provisional FPD. (d) Radiograph of tooth #11 before the removal of provisional FPD.
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The FPD was removed without local anesthesia to further evaluate the teeth. Tooth #11 appeared to have a bright red hemorrhage-like hue whereas tooth #6 appeared normal (Figures 1(a) and 1(b)). A radiographic examination revealed an intact periodontal ligament (PDL) space around tooth #11 with no obvious periapical pathology (Figures 1(c) and 1(d)).
(a) Rubber dam isolation of tooth #11. (b) Initial access preparation showing hemorrhagic pulpal tissue. (c) Extirpated pulpal tissue on hedstrom file. (d) Irrigation with 6% sodium hypochlorite solution in a pulp chamber. Tooth immediately changed color due to oxidation of hemoglobin.
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Tooth isolation was achieved with a ligated endodontic clamp and a latex rubber dam (Figure 2(a)). With the use of a dental operating microscope, hemorrhagic vital pulp tissue was found inside the pulp chamber upon access (Figure 2(b)). Although the pulp tissue was still vital, the tissue did not have a healthy appearance (Figure 2(c)). Copious irrigation of 6% sodium hypochlorite solution was used during the cleaning and shaping process, followed by a final rinse of 17% ethylenediaminetetraacetic acid (EDTA) to remove the smear layer (Figure 2(d)).
(a) Clinical photograph of the obturated tooth #11 prior to placing a temporary filling and the provisional FPD. (b) Postoperative radiograph of the obturated tooth #11 with the provisional FPD cemented.
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The backfill was accomplished with Continuous Wave Obturation system (Kerr Dental, Orange, CA, USA) to achieve a three-dimensional fill and to eliminate possible voids (Figure 3(a)). Two Harbors, MN, USA). The provisional FPD was recemented with Durelon (Figure 3(b)).