PMC7273397_01
Periapical radiograph showing that tooth 22 had a well-condensed root canal filling, where the gutta percha was overextended with a periapical lesion at the area.
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Periapical radiograph showed that tooth 22 had a well-condensed root canal filling; however, the gutta percha was overextended and there was periapical lesion at the area (Figure 1).
Cone Beam Computed Tomography (CBCT) of tooth 22 with a periapical lesion.
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Tomography (CBCT) revealed that the size of the lesion was approximately 2 mm x 2 mm (Figure 2). The provisional diagnosis was a failure root canal-treated tooth with chronic apical periodontitis and discolored tooth.
Periapical radiograph of tooth 22 after GP removal with a Hedstrom file.
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Apical gutta percha was hooked and removed with the Hedstrom file #40 and #45 (DiaDent, South Korea) (Figure 3).
Periapical surgery procedure of tooth 22: (a) flap preparation, (b) enucleation of lesion, (c) bone preparation for graft, and (d) bone graft placement.
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Freeze-dried cancellous Osteo-Lamb bone graft (USM Tissue Bank, Malaysia) was placed at the bony defect to encourage the growth of key surrounding tissue (Figure 4).
Histopathological finding of lesion: (a) collagenous tissue with mature fibroblasts, patchy chronic inflammatory cells, scanty vascular channels, and nerve bundle; (b) loosely edematous background with admixed hemorrhage, numerous capillaries, and intense inflammatory cells comprising lymphoplasma cells, macrophages, and neutrophils.
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A focal area shows a loosely edematous background with admixed hemorrhage, numerous capillaries, and intense inflammatory cells comprising lymphoplasma cells, macrophages, and neutrophils (Figure 5).
Posttreatment radiograph after 6 months.
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During 6 months of review, the healing was successful and the patient denied any complaint (Figure 6).
One year follow-up in radiograph with patient's tooth color appearance.
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One-year follow-up showed an almost complete healing of the lesion, and acceptable tooth color appearance (Figure 7).