A 27 year old male patient presented with a non-painful suppurating swelling associated with his LL7 [Figure A]. An impacted partially erupted LL8 causing a deep distal cavity had been extracted 5 years previously and the distal surface of the LL7 had been restored. A GP cone placed into the sinus tracked along the distal root surface of the LL7 with no significant periradicular radiolucency observed [Figure B].
|Figure A||Figure B|
A limited volume CBCT scan showed a large periradicular radiolucency extending from the root apex up along the distal wall of the root, creating a substantial J-shaped lesion, often seen in vertical root fracture. The C-shaped root configuration with complex curved C-shaped canal anatomy was surprising, given the original periapical radiograph [Figure C]. Access and examination with an operating microscope confirmed no vertical fracture was present [Figure D]. Since standard endodontic instrumentation cannot hope to effectively clean and decontaminate non-circular canal systems, the Self-Adjusting File (RedentNova) was used to thoroughly disinfect this complex canal system. Obturation was carried out using a Bioceramic sealer and warm GP to effectively flow and seal the intricacies [Figure E]. The result can be seen to appear satisfactory both clinically and radiographically [Figure F], but the spectacular effect of this treatment is evident 8 months later using an ultra-low dose CBCT review scan. The obturation can be seen to beautifully seal the canal complexities, and healing of the large lesion is virtually complete.
|Figure C||Figure D||Figure E||Figure F|
|Before After||Before After||Before After|
Author: Dr Richard Kahan
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