PMC4052928_01
(a) Preoperative intraoral photograph showing a gingival abscess in the mandibular right second premolar. (b) Panoramic X-ray showing extensive radiolucency in the periradicular region in the mandibular right second premolar compared with the mandibular left second premolar. (c) X-ray showing an immature open apex and enlargement of the periodontal ligament space and extensive radiolucency in the periradicular region in the mandibular right second premolar.
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Furthermore, an intraoral examination revealed a gingival abscess in the region of the mandibular right second premolar (Figure 1(a)). Radiographic findings showed enlargement of the periodontal ligament space, along with extensive radiolucency in the periradicular region in the area of the mandibular right second premolar as compared with the mandibular left second premolar (Figures 1(b) and 1(c)).
(a) Intraoral photograph showing no abnormalities of gingiva. (b) The central cusp of the mandibular right second premolar had been fractured. (c) After controlling hemorrhage, viable tissue was observed in the canal because insertion of a K-file evoked a sensation. (d) Placement of MTA in the canal. (e) Postoperative X-ray photograph showing MTA placement in canal.
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Postsurgery intraoral examination showed no abnormalities on the gingiva of the mandibular right second premolar (Figure 2(a)). However, the talon cusp of the mandibular right second premolar was fractured (Figure 2(b)). Upon entering the coronal aspect of the root canal, hemorrhaging into the pulp chamber was observed (Figure 2(c)). Next, MTA (Pro-Root MTA, Dentsply Sankin, Tochigi, Japan) was packed into the canal using MAP system (Dentsply Sankin, Tochigi, Japan) (Figure 2(d)) and the access cavity was closed with glass-ionomer cement (Fuji IX GP, GC, Tokyo, Japan). An X-ray obtained after the procedure confirmed MTA placement in the canal (Figure 2(e)).
(a) Intraoral photograph showing no abnormalities of gingiva. (b) Panoramic X-ray photograph showing the formation of a dentin bridge in the mandibular right second premolar. (c) X-ray shows that radiolucency became less radiolucent in the periradicular region and the formation of a dentin bridge in the mandibular right second premolar.
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Six months later, an intraoral examination showed no abnormalities in the gingiva of the mandibular right second premolar (Figure 3(a)), while an X-ray photographic evaluation showed formation of a dentin bridge in the mandibular right second premolar (Figures 3(b) and 3(c)).
(a) Intraoral photograph showing no abnormalities of gingiva. (b) Panoramic X-ray showing the formation of a dentin bridge and thickening of the canal walls in the mandibular right second premolar. (c) Panoramic X-ray showing the formation of a dentin bridge and thickening of the canal walls and establishment of the periodontal ligament space and lamina dura in the mandibular right second premolar.
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Ten months later, an intraoral examination showed no abnormalities of the gingiva in the mandibular right second premolar (Figure 4(a)), and X-ray images revealed formation of a dentin bridge and thickening of the canal walls in the mandibular right second premolar (Figures 4(b) and 4(c)).