PMC4438176_01
(a) Drained sinus tract on the top side of alveolar crest. (b) Suppuration from the sinus tract. (c) Tracking of the sinus tract with gutta-percha point. (d) Access cavity and rubber dam. (e) Clinical situation after complete healing (18 months after the treatment).
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Accurate examination of the distal attached gingiva revealed a draining sinus tract on the top of alveolar ridge, which suppurated upon digital compression (Figures 1(a) and 1(b)). The sinus tract was explored with a gutta-percha cone to the apical area of the mandibular right second premolar (Figures 1(c) and 2(b)). A rubber dam (Coltene Whaledent, Langenau, Germany) was placed and, after caries removal, an access cavity was prepared (Figure 1(d)). The postoperative appointment six months after augmentation showed no remaining evidence of the sinus tract; radiographically, the periapical area showed a complete healing (Figures 1(e) and 2(g)).
(a) Periapical radiograph prior to root canal treatment. (b) Tracking of the sinus tract with gutta-percha point. (c) Determination of working length. (d) Master point radiograph. (e) Completed root canal treatment. (f) Reconstruction with fibre post and metal-ceramic crown; partial healing of the bone defect. (g) Radiographic situation after complete healing. (h) Radiographic situation of the implant after five years in situ.
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However, a radiographically visible periapical lesion, involving the distal region of the mandible (radiolucent area, see Figure 2(a)), was evident. By initial placement of a number 15 silver point (VDW), using an individualized X-ray holder, radiographic working length was determined (Figure 2(c)). The preparation of the root canal was performed to ISO size 35 master point, up to a working length of 15.5 mm (Figure 2(d)) as intracanal antibacterial interim dressing (calcium hydroxide; Ultracal XS; Ultradent, South Jordan, UT, US) was used. Sanofi-Aventis, Frankfurt, Germany). During this period the patient remained asymptomatic; meanwhile upon radiographic investigation the periapical area showed signs of partial bony recovery. Subsequently, the root canal obturation with gutta-percha points (VDW) and resinous sealer (AH Plus; Dentsply Maillefer, Ballaigues, Switzerland) was performed using the lateral condensation technique (Figure 2(e)). Six weeks later the endodontically treated premolar was reconstructed with a fibreglass post and a composite restoration (Figure 2(f)). Subsequently, the patient underwent prosthetic treatment of his advanced tooth wear (including the described tooth) by means of metal-ceramic crowns (Figures 2(f) and 2(g)). Radiographically, the periapical area showed a partial bony recovery, comparable to the situation several weeks after endodontical treatment (Figure 2(f)). The implant remained stable after five years of evaluation (Figure 2(h)).