PMC7725588_01
Preoperative clinical view. Note the reddening and inflammation at the buccal level of 1.1 and 2.1 and of the interdental papilla, as well as grayish buccal and apical staining of the central incisors, caused by the presence of the silver amalgam filler material.
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The intraoral exploration revealed reddening and inflammation at the buccal level of 1.1 and 2.1 and of the interdental papilla, as well as grayish buccal and apical staining of the central incisors, caused by the presence of the silver amalgam filler material (Figure 1).
Preoperative periapical radiograph showing a radiolucent image around the root of 1.1 and a larger radiolucency around 2.1.
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The periapical radiographs revealed radiolucencies around the apexes of 1.1 and 2.1 (Figure 2).
Preoperative sagittal CBCT view showing destruction of the buccal cortical layer of 2.1.
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Cone beam computed tomography (CBCT) (Planmeca , Helsinki, Finland) evidenced bone destruction at 1.1 (Figure 3) and 2.1, with the involvement also of the buccal cortical layer of 2.1 (Figure 4).
Preoperative three-dimensional radiographic reconstruction showing destruction of the buccal cortical layer of 2.1.
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Cone beam computed tomography (CBCT) (Planmeca , Helsinki, Finland) evidenced bone destruction at 1.1 (Figure 3) and 2.1, with the involvement also of the buccal cortical layer of 2.1 (Figure 4).
Submarginal incision.
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A number 15C scalpel was used to perform a horizontal submarginal incision (Figure 5) at 3-4 mm from the gingival margin, with vertical releasing incisions distal to 1.2 and 2.2 and the raising of a full-thickness mucoperiosteal flap (Figure 6).
Raising of the full-thickness mucoperiosteal flap.
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A number 15C scalpel was used to perform a horizontal submarginal incision (Figure 5) at 3-4 mm from the gingival margin, with vertical releasing incisions distal to 1.2 and 2.2 and the raising of a full-thickness mucoperiosteal flap (Figure 6).
Ostectomy and curettage of the periapical lesions of 1.1 and 2.1.
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The periapical inflammatory tissue was removed for posterior histopathological study (Figure 7), and inspection of the roots of 1.1 (Figure 8) and 2.1 (Figure 9) was made using a rigid endoscope (Karl Storz ,
Endoscopic view of 1.1 before removal of the old filler material.
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The periapical inflammatory tissue was removed for posterior histopathological study (Figure 7), and inspection of the roots of 1.1 (Figure 8) and 2.1 (Figure 9) was made using a rigid endoscope (Karl Storz ,
Endoscopic view of 2.1 before removal of the old filler material.
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Clinical view of the removal of the old filler material of 1.1 and 2.1.
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Tuttlingen, Germany), with the application of methylene blue dye to the zone in order to discard possible root fractures. The silver amalgam was removed from the retrograde cavities using ultrasound tips (Piezomed , W&H, Burmoos, Austria) (Figure 10).
Endoscopic view of 1.1 after removal of the old filler material and checking of retrograde cavity integrity.
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The endoscope was used to check that the retrograde cavities of 1.1 (Figure 11) and 2.1 (Figure 12) were well prepared and clean.
Endoscopic view of 2.1 after removal of the old filler material and checking of retrograde cavity integrity.
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The endoscope was used to check that the retrograde cavities of 1.1 (Figure 11) and 2.1 (Figure 12) were well prepared and clean.
Clinical view of filling with MTA of the retrograde cavities of 1.1 and 2.1.
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Bleeding was controlled with dressing impregnated with epinephrine, and the retrograde cavities of both teeth were filled with MTA (ProRoot , Dentsply, York, USA) (Figure 13).
Endoscopic view of 1.1 after filling of the retrograde cavity with MTA.
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Once the filler material had set, the endoscope was used to confirm correct completion of the retrograde filling of 1.1 (Figure 14) and 2.1 (Figure 15).
Endoscopic view of 2.1 after filling of the retrograde cavity with MTA.
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Once the filler material had set, the endoscope was used to confirm correct completion of the retrograde filling of 1.1 (Figure 14) and 2.1 (Figure 15).