PMC7714592_01
Images of the 27-year-old patient presenting an extensive asymptomatic lesion of the right posterior mandible. (a) The panoramic radiograph shows a well-defined unilocular osteolytic lesion with sclerotic margins located between the two molar teeth and superimposed on the alveolar inferior nerve. (b) The periapical radiograph of the first molar depicting inadequate root canal treatment with signs of perforation in the apical third of the distal root involved in the osteolytic lesion. (c) B-mode ultrasound examination showing a transonic lesion (arrows). (d) Power-Doppler image showing the presence of peripheral vascularity.
CRID2020-8829305.001.jpg
PMC7714592_01_CRID2020-8829305.001.jpg
fig1
A preoperative periapical radiograph taken using the paralleling technique confirmed these findings (Figure 1). The exam displayed a transonic, fluid-filled lesion with a well-defined hyperechoic bone contour, perilesional vascularity, and no internal vascular supply, suggestive of a cystic lesion (Figure 1).
(a) CBCT revealing a well-defined unilocular lesion between the second and first right mandibular molars. (b) Sagittal view showing the expansion of the lesion toward the lingual wall and the consequent thinning of the lingual plate. (c) Axial section showing a perforation in the distal and lingual aspects of the apical third of the distal root of the right first molar. (d) The main osteolytic lesion appears in continuity with the perforation in the distal root of the right mandibular first molar.
CRID2020-8829305.002.jpg
PMC7714592_01_CRID2020-8829305.002.jpg
fig2
From the axial and sagittal sections, it was possible to diagnose a perforation both in the distal and lingual aspects of the apical third of the distal root of the right first molar (Figure 2).
(a) Intraoperative view showing the bone cavity filled with serum sanguineous fluid. (b) Gross specimens of small dimensions collected for histopathological examination. (c) Hematoxylin-eosin histology slide containing the tissue fragments. (d) Photomicrograph shows the lesion to be composed of fibrosclerotic tissue with calcifications and cholesterol clefts and the absence of epithelium. (e) Histopathological section revealing the presence of a chronic inflammatory infiltrate with numerous foamy histiocytes and multinucleated giant cells.
CRID2020-8829305.003.jpg
PMC7714592_01_CRID2020-8829305.003.jpg
fig3
Histologic examination of the tissue fragments reported fibrosclerotic tissue with calcifications and cholesterol clefts, extensively interested in a chronic inflammatory infiltrate with numerous foamy histiocytes and foreign body-like multinucleated giant cells (Figure 3).
(a) Postoperative periapical radiograph showing root canal treatment of the second mandibular molar. (b) Four-month periapical radiograph showing an increase in radiopacity and trabeculae formation in the area of the intervention. (c) Four-month clinical photograph. (d) Two-year follow-up periapical radiograph. (e) Five-year follow-up periapical radiograph showing both repair of the distal root and bone healing. (f) Clinical photograph at the five-year recall visit.
CRID2020-8829305.004.jpg
PMC7714592_01_CRID2020-8829305.004.jpg
fig4
The apical half of the distal canal was dried with paper points and obturated using Ortho-MTA (BioMTA, Seoul, Republic of Korea) applied with a carrier to seal the perforating defect, while the remaining coronal half was filled with flowable gutta-percha and the tooth restored with composite (Figure 4). Four months later, the patient was asymptomatic, and radiographic control showed an increase in radiopacity and trabeculae formation in the bone (Figure 4). An additional CBCT examination depicted the complete formation of the vestibular and lingual cortical plates (Figures 4 and 5).
Panoramic radiograph showing complete healing and absence of recurrence after five years. (b-d) Five-year CBCT examination showing complete healing of the lesion. (c-e) The sagittal and axial views demonstrate remineralization of the area around and within the perforated root and depict the complete formation of the vestibular and lingual cortical plates.
CRID2020-8829305.005.jpg
PMC7714592_01_CRID2020-8829305.005.jpg
fig5
An additional CBCT examination depicted the complete formation of the vestibular and lingual cortical plates (Figures 4 and 5).