Page 13 - The Beauty and Sorrow in Endodontics-Prologue

(Fig 3D) (Fig 3E)
6-months post-op – Near complete 1-year post-op – Complete healing of

healing around the apical radiolucency. the apical radiolucent lesion with
reformation of the lamina dura.

A female patient in her 30s presented with swollen gum around the left
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mandibular second premolar ( 35). Radiographic examination revealed a radiolucent
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lesion around the apex of 35 (Fig 3A). Generally, one would expect a lateral canal exit at
the location where there is a sudden widening of the PDL space (radiolucent area). In
other words, other than normal anatomical structures such as sinus, mental foramen, or

the inferior alveolar nerve (IAN) canal, radiolucent lesions should not be present around
healthy teeth. Ergo, when a radiolucent lesion is present, it is indicative of a defective
boney structure, and one should visualize it as a three-dimensional spherical defect.

Imagine a tangent line from the most raised point of the spherical lesion, the point where
a perpendicular line to this tangent meets the root surface is where the lateral canal exits.
Toxins originating from the pulp chamber and root canal systems accumulate the fastest
and the most abundant at these root canal exits/openings, and therefore, will destroy the
most amount of bone structure. Consequently, the entire root canal treatment, from

cleaning and shaping, all the way to obturation, must be accurate. When performed
properly, the post-obturation radiograph will reveal the densely sealed lateral canals at the
predicted location.

In this case, the suspected lateral canal can be seen obturated on the radiograph
(Fig 3B). White sealer puffs are also evident on the radiograph as sealers are pushed out
of the root canal once the compacted warm gutta percha fills the entire root canal system;
they do not affect healing. Follow-ups at six weeks (Fig 3C), six months (Fig 3D), and

one year (Fig 3E) show progressive healing, including reformation of the lamina dura.

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