PMC5996454_01
Case 1. (a) The initial radiograph of tooth #46 shows periapical and furcation bone resorption. (b) The 1-year recall radiograph shows healing of the bone lesion. (c) The 6-year follow-up radiograph shows tooth #46 with a permanent crown.
CRID2018-7084245.001.jpg
PMC5996454_01_CRID2018-7084245.001.jpg
fig1
Follow-up X-ray images were obtained from 1 year to 6 years, which showed complete healing of the bone in the periapical and furcation areas (Figure 1).
PMC5996454_02
(a) Tooth #36 has a perforation in the distal root. The post is shown after removal, as is a paper point with a blood spot. (b) The mineral trioxide aggregate (MTA) repair. The recall examinations show osseous regeneration in the furcation. (c) The follow-up clinical photograph of tooth #36 shows the final crown and normal soft tissue.
CRID2018-7084245.002.jpg
PMC5996454_02_CRID2018-7084245.002.jpg
fig2
Periodontal probing through the furcation showed increased probing values with a grade II defect (Figure 2). The perforation site was irrigated with 2.5% sodium hypochlorite followed by drying of the canal and sealing of the perforation with mineral trioxide aggregate (MTA; Dentsply Tulsa Dental) mixed with saline and placed with a microapical placement system (Dentsply Tulsa Dental) and condensed with a paper point (Figure 2).
PMC5996454_03
(a) A deep periodontal pocket and drainage of pus through the gingival sulcus are visible. (b) Radiographs of tooth #22 exhibit (i) a large lateral radiolucency on the mesial tooth surface extending from the bone crest to the root apex, (ii) calcium hydroxide [Ca(OH)2] placement, (iii) root canal obturation, and (iv) bone healing. (c) Surgical exposure of tooth #22 shows calculus accumulation and granulation tissue mesially with the absence of buccal bone. (d) Removal of calculus and granulation tissues and placement of the bone graft. (e) Placement of the barrier membrane; the 30-month recall photograph shows normal gingival tissue.
CRID2018-7084245.003.jpg
PMC5996454_03_CRID2018-7084245.003.jpg
fig3
Clinical and radiographic examinations revealed a sound tooth #22 with a mobility of grade II and a deep periodontal pocket > 10 mm mesial to tooth #22 with pus discharge from the pocket (Figure 3(a)). The radiographic examination showed advanced bone resorption extending from the mesial bone crest toward the apex of tooth #22 (Figure 3(b)). The first stage of the treatment plan was endodontic treatment, which was performed during two visits with calcium hydroxide medication between appointments (Figure 3(b)). The canal was obturated with lateral condensation of gutta-percha and AH Plus sealer (Dentsply Maillefer, Tulsa, OK, USA) (Figure 3(b)). The second stage of the treatment plan, which was a surgical procedure, was performed after the permanent composite restoration and a follow-up period of 3 months. After flap reflection, a sling suture was placed in the tissue flap to secure it with the premolar tooth on the opposite side of the maxillary arch to aid the surgeon in improving visual and operative access by eliminating the need to manually retract the flap in the palatal area (Figure 3(c)). After removing the granulation tissues and calculus from the root surface with ultrasonic tips (Figures 3(c) and 3(d)), bone graft material (Puros Particulate Allograft; Zimmer Biomet Dental) mixed with saline was placed into the bony defect with a plastic instrument, and a resorbable barrier membrane (CopiOs membrane, Zimmer Biomet Dental) was placed above the bone graft. Follow-up of the patient showed no tooth mobility, a reduced pocket depth of 4 mm, and healing of the soft and hard tissues (Figure 3(e)).