PMC3916507_01
A series of periapical radiographs of the mandibular left first molar of case 1. (a) A preoperative radiograph showed radiolucency around both the mesial and distal roots and a gutta percha cone traced to the apex of distal root; (b) A postoperative radiograph after obturation of 4 canals; (c) A periapical radiograph at a 1-year routine check-up; (d) A periapical radiograph at a 3-year routine check-up; (e) and (f) Periapical radiographs at an 8-year routine check-up.
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F1
A periapical radiograph showed apical radiolucencies on both roots, and there was no alveolar bony support around the distal root (Figure 1a). The canals were obturated with the continuous wave technique using System B and Obtura II (Figure 1b). During an 8-year follow up, the patient remained asymptomatic, and the periapical radiolucency disappeared (Figures 1c - 1f).
PMC3916507_02
Periapical radiographs of case 2. (a) A preoperative periapical radiograph showed a J-shaped radiolucency on the mesial root of mandibular right first molar; (b) A preoperative radiograph with a different horizontal angle. The distal root also had a J-shaped lesion, which could be suspected of being a vertical root fracture; (c) A periapical radiograph for the working length determination; (d) A postoperative radiograph after canal filling; (e) A periapical radiograph at a 3-month routine check-up; (f) A periapical radiograph at a 6-month routine check-up; (g) A periapical radiograph at a 1-year routine check-up; (h) A periapical radiograph at a 2-year routine check-up.
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F2
Large periapical lesions in both roots and a J-shaped alveolar bone defect in the mesial root were observed in the periapical radiographs (Figures 2a and 2b). Three canals were found and enlarged to a 0.04 taper of the #35 Profile (Figure 2c). The canals were obturated, and a composite resin core was built (Figure 2d). At a 3-month follow up (Figure 2e), the patient was asymptomatic and sent to the department of prosthodontics for a crown restoration. The tooth underwent routine check-ups and was asymptomatic through a 2-year follow up (Figures 2f - 2h).
Preoperative views of #46 of case 2 using cone-beam computed tomography (CBCT). (a) A coronal view of the mesial root and the surrounding bone of #46; (b) A coronal view of the distal root and the surrounding bone of #46; (c) A sagittal view of the mesial root and the surrounding bone of #46; (d) A sagittal view of the distal root and the surrounding bone of #46.
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F3
A cone-beam computed tomography (CBCT, Pax-Zenith3D, Vatech, Yongin, Korea, 104 kVp, 5.5 mA) was also performed to rule out a vertical root fracture (Figures 3a - 3d).
PMC3916507_03
A series of periapical radiographs, computed tomographic (CT) views, and clinical photos of the mandibular left second molar of case 3. (a) A preoperative periapical radiograph of #37; (b) A preoperative radiograph of #37 with a gutta percha cone traced to the furcation area; (c) and (d) Periapical radiographs obtained at a second visit of the endodontic treatment of #37. A sinus tract formed and was traced to the distal surface of the tooth; (e) and (f) Postoperative radiographs of #37 after canal filling; (g) and (h) CT views from sagittal and axial planes demonstrated the tooth fragment of #38; (i) An extracted second molar for intentional replantation. Calculus deposition was noticed on the furcation of the distal root; (j) A tooth fragment of #38 was removed through an extraction socket of #37; (k) A postoperative radiograph after intentional replantation of #37; (l) A periapical radiograph at a 1-year routine check-up; (m) and (n) A periapical radiograph at a 2-year routine check-up.
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F4
A sinus tract was traced to the distal aspect of the distal root (Figures 4a and 4b). Even after 3 canal preparations were completed up to #35 and copious 2.5% NaOCl irrigation was performed, the sinus tract on the distal side remained (Figures 4c and 4d). Computed tomography (CT, Somtom Sensation 64, Siemens, Erlangen, Germany, 120 kVp, 90 mA) was performed to evaluate the location of the fragments, which were observed on the distal proximity of #37 (Figures 4g and 4h). While an endodontist worked with the extracted #37, an oral surgeon removed the tooth fragment from the extraction socket of #37 (Figures 4i and 4j). Total tooth fragment removal was confirmed with periapical radiographs (Figure 4k). The 1- and 2-year follow-up radiographs revealed a gradual decrease in radiolucency (Figures 4l - 4n).