PMC6942740_01
MRI sagittal and axial views show thickness of mucosal layer of maxillary sinus.
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Cervical spine MRI was normal and brain MRI showed chronic sinusitis (Figure 1).
Orthopantomogram before treatment showed the upper left second molar opened with periapical radiolucency.
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Radiograph examination in orthopantomogram and periapical (Figures 2 and 3) showed radiolucency around upper 6 and 7 and arrived at the border of the maxillary sinus using rubber dam for isolation starting with using a cold and percussion test to determine the vitality of pulp, upper 6 positive on cold but there is no pain on percussion and upper 7 pain on percussion but negative on cold.
Periapical X-ray before treatment.
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Radiograph examination in orthopantomogram and periapical (Figures 2 and 3) showed radiolucency around upper 6 and 7 and arrived at the border of the maxillary sinus using rubber dam for isolation starting with using a cold and percussion test to determine the vitality of pulp, upper 6 positive on cold but there is no pain on percussion and upper 7 pain on percussion but negative on cold.
Periapical X-ray shows gutta-percha inserted through sinus.
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Our initial diagnosis was upper left second molar previously initiated therapy with chronic apical abscess with sinus tract; the upper left first molar was diagnosed with irreversible pulpitis; normal apical tissues used gutta-percha to determine the caused tooth of sinus track (Figures 4 and 5).
Gutta-percha inserted through sinus.
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Our initial diagnosis was upper left second molar previously initiated therapy with chronic apical abscess with sinus tract; the upper left first molar was diagnosed with irreversible pulpitis; normal apical tissues used gutta-percha to determine the caused tooth of sinus track (Figures 4 and 5).
Upper left first molar with calcium hydroxide shows the tooth with direct contact with sinus.
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Irrigation with sodium hypochlorite was done, and then normal saline was used for final irrigation, canal was dried using F1 paper point, and calcium hydroxide with iodoform as an internal canal medication (Figure 6).
Periapical due to upper 7 obturation.
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Gutta percha and hot Gutta system with endomethazone and eugenol as a sealer. Glass ionomer was used to close the pulp chamber then completing the tooth filling using composite (Figure 7).
CBCT.
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CBCT after obturation. Axial, coronal, and sagittal views.
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Periapical X-ray after 2 weeks of obturation.
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CBCT after 10 months of obturation.
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