PMC5183744_01
(a) Clinical photograph showing normal periodontal tissues; (b) initial panoramic radiograph; (c) teeth #42 and #43 with open access cavities and exposed pulp prior to instrumentation, demonstrating an error in endodontic diagnosis; relationship between clinical crowns and periapical radiographs.
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Initially, we observed slight expansion of the cortical bone in the apical region of #42 and #43, but the periodontal tissues were normal and there was no sinus tract (Figure 1(a)). Periapical radiographs of the area showed a radiolucent lesion with boundaries extending beyond the dimensions of the periapical film (Figures 1(b) and 1(c)).
Surgical access through the anterior mandible for decompression of periapical lesion. (a) Cavity after packing (b) with gauze impregnated with antibiotic ointment (c).
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Surgical access to the anterior mandible was obtained with a scalpel and #6 carbide bur mounted on a high-speed handpiece (Figure 2).
Periapical radiographs obtained immediately after obturation of root canals.
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Briefly, the canals were cleaned and shaped to 1 mm short of full length, using Protaper  rotary instrumentation (Dentsply-Maillefer, Ballaigues, Switzerland), followed by obturation with Protaper F2 gutta-percha cones (Dentsply-Maillefer) and Grossman's cement (Endofill, Dentsply Industria e Comercio Ltda, Petropolis, RJ, Brazil), using the lateral condensation technique (Figure 3).
(a) Panoramic radiograph obtained at 4-year follow-up. Bone repair is clearly visible; (b) cone-beam computed tomography image (axial slice), demonstrating bone repair. A possible fibrotic bone scar is visible (arrow).
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When she resumed contact, plain radiographs (Figure 4(a)) were obtained and computed tomography was performed (Figure 4(b)).