Periapical radiolucencies are commonly associated with pulpal necrosis and microbial infection of the root canal system. Successful root canal treatment (RCT) aims to eliminate intracanal infection and promote periapical tissue healing. This case report describes the nonsurgical endodontic treatment of a maxillary lateral incisor presenting with a periapical radiolucency. Following proper biomechanical preparation, irrigation, and obturation, clinical symptoms resolved, and follow-up radiographic examination demonstrated significant reduction and healing of the periapical lesion. The case highlights the effectiveness of conventional root canal therapy in managing periapical pathosis and facilitating periapical bone regeneration.
Periapical lesions develop as a consequence of pulpal infection and the host inflammatory response. Radiographically, these lesions appear as radiolucent areas around the root apex. The primary objective of endodontic treatment is to eradicate microorganisms from the root canal system and create conditions favorable for healing of the periapical tissues.
patient presented with discoloration and a history of pain associated with the maxillary left lateral incisor. Clinical examination revealed a non-vital tooth, while periapical radiography showed a well-defined periapical radiolucency. Nonsurgical root canal treatment was performed under rubber dam isolation. After access preparation, working length determination, canal instrumentation, copious irrigation with sodium hypochlorite, and final irrigation protocol, the canal was obturated using gutta-percha and resin sealer. The tooth was subsequently restored with a definitive coronal restoration
The patient remained asymptomatic during follow-up visits. Radiographic evaluation after several months demonstrated progressive reduction in the size of the periapical radiolucency, indicating successful healing and regeneration of the periapical tissues.
Conventional root canal treatment can successfully resolve periapical pathology associated with necrotic teeth. Adequate disinfection of the root canal system and a well-sealed obturation contribute significantly to the healing of periapical radiolucencies and long-term treatment success.
Initial Situation:
The patient presented with a severely compromised maxillary lateral incisor showing extensive coronal destruction and a grayish discoloration. Clinical examination revealed significant loss of tooth structure due to advanced caries and/or previous trauma, with only a small portion of the crown remaining. The gray discoloration suggested pulpal necrosis or previous endodontic pathology.
Radiographic Findings:
A large, well-defined periapical radiolucency is present around the apex of the affected anterior tooth.
There appears to be loss of the normal lamina dura surrounding the root apex.
The lesion extends beyond the immediate periapical region, suggesting significant periapical bone destruction.
The associated tooth is likely non-vital, correlating with the gray discoloration and extensive coronal breakdown seen clinically.
Master cone
Master (35/4)
Following rubber dam isolation, endodontic access was established through the remaining coronal tooth structure. Caries and unsupported tooth structure were removed, and an access cavity was prepared to gain straight-line entry into the root canal system. The necrotic pulp chamber was debrided, and canal orifice localization was achieved. The procedure facilitated thorough canal disinfection and subsequent endodontic treatment while preserving the remaining sound tooth structure.
Master apical file 35
X ray reveals master cone with full working length
Lateral Compaction Technique
After completion of cleaning, shaping, and drying of the root canal, a master gutta-percha cone corresponding to the master apical file size (#35/.04 in this case) was selected and fitted to the working length with adequate tug-back.
A root canal sealer was then applied to the canal walls and the master cone was inserted to the full working length. A finger spreader was introduced alongside the master cone to create lateral space within the canal. Upon withdrawal of the spreader, an accessory gutta-percha cone coated with sealer was placed into the created space.
This procedure was repeated several times using additional accessory cones until the spreader could no longer penetrate beyond the coronal third of the canal, indicating adequate compaction and complete filling of the root canal system. Excess gutta-percha was removed at the canal orifice and vertically condensed to achieve a dense and homogeneous obturation.
Obturation
X ray reaveals obturation with good apical seal
3 months follow up
The story
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