Page 19 - The Beauty and Sorrow in Endodontics-Chapter 3

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O I/O: 11 No caries, M3, STP (+), Displaced
Rad: 11 Periapical radiolucency and bone loss (Fig 33A)
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A Dx: 11
Pulpal: Previously initiated

Periapical: Symptomatic apical periodontitis
Etiology: unknown endodontic or periodontal since treatment had been initiated

P Discussed proposed treatment plan with the patient. Informed consent obtained to

proceed.
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1) 11 Root canal treatment
# 11 root canal treatment completed following the standard protocol for
cleaning, shaping, and obturation. Overfilling of the primary canal and multiple

lateral canals can be seen on the post-obturation radiograph (Fig 33B). The

patient was aware of the guarded prognosis for the tooth even after completion of
root canal treatment

2) Follow-up
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3-weeks – Decreased mobility of 11 (from M3 to M2). Occlusal adjustment was
made to remove any premature contact and to ensure no further

occlusal trauma to the tooth.
3-months– The patient was happy with the result and decreased mobility.

However, significant bone loss was still evident on the radiograph,
therefore, open flap surgery and bone graft was recommended. Both

buccal (Fig 33C) and palatal (Fig 33D) bone loss was evident once the
flap was raised, and significant amount of calculus was present from

mid-root to root tip.

3-months after bone graft – 11 presented with normal mobility and healed apical
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lesion (Fig 33E). Fiberpost and resin core was placed to ensure good

coronal seal.
1-year (9-months after bone graft) – Reformation of 11 lamina dura observed
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(Fig 33F).
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3-years – Complete healing of the 11 apical lesion observed (Fig 33G).

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