A 28-year-old male patient reported with the chief complaint of hollowing and discoloration of upper front teeth. The teeth were traumatized 10-12 years back [Table/Fig-1a]. Patient had undergone root canal treatment of 21 seven years back. Root canal of 12 was accessed elsewhere two days before the patient reported to the Department of Conservative Dentistry and Endodontics at Hitkarini Dental College and Hospital, Jabalpur, India. [Table/Fig-1a,b]: (a) Pre-operative picture showing hollowed and discoloured 11 and discoloured 21 and pre-operative IOPA radiograph revealed Internal resorption in 11, iatrogenic lateral perforation in 12, incomplete obturation in 21. On intraoral examination, there was a draining sinus, in relation to carious 11. Periodontal examination revealed a clinical probing depth of 5 mm in relation to 11, measured with Naber’s probe. Intraoral periapical radiograph revealed internal resorption in 11, iatrogenic lateral perforation with 12, incomplete obturation of 21[Table/Fig-1a]. Endodontic treatment of 11, 12 and re-treatment of 21 followed by flap debridement along with placement of MTA and PRF at the perforation site was planned. First phase included Tooth 11: After complete removal of infected dentin and irrigation with sodium hypochlorite. Working length was radiographically determined. Intracanal calcium hydroxide paste was placed and access cavity was sealed with Cavit temporary filling material. On recall examination next week, the sinus opening disappeared. The calcium hydroxide was flushed out and canal was irrigated with normal saline. After drying the canal with paper points, sectional obturation was performed using 60 (2%) master cone by vertical compaction with appropriate sized hand plugger, using AH-Plus sealer. After sectional obturation a fiber post was cemented with a core buildup material [Table/Fig-1b]. Tooth 12: Pulp was extirpated after modification of access cavity. The canal was cleaned and shaped. Tooth was obturated with gutta percha using lateral compaction method [Table/Fig-1b]. Tooth 21: Complete removal of gutta purcha was done using rotary re-treatment files and H file. After cleaning and shaping, ortho grade obturation was done with 70 (2%) master cone with lateral compaction [Table/Fig-1b]. Patient was recalled for 2nd phase of treatment. Full thickness mucoperiosteal flap was reflected extending from middle of the canine region of 1st quadrant to distal of lateral incisor of 2nd quadrant. The perforation site was exposed [Table/Fig-2a, 2b]. [Table/Fig-2a,f]: (a),(b) Mucoperiosteal flap raised and perforation site exposed. All the granulation tissue was curetted. The surgical field was cleaned, dried and MTA was placed at the site of perforation [Table/Fig-2c]. Intravenous blood was collected and PRF was prepared in a centrifugation machine [Table/Fig-2d]. After which PRF was placed on the surgical field [Table/Fig-2e]. The mucoperiosteal flap was repositioned and simple interrupted sutures were given using absorbable vicryl suture. Post-operative care was explained to the patient, with instructions to report back after a week for checkup [Table/Fig-2f]. After one month, fixed crowns were placed. Follow-up recall demonstrated satisfactory healing [Table/Fig-3b-3e,3g,3h]. Periodontal examination revealed reduction in clinical probing depth of 5 mm to 3 mm in relation to 11, measured with Naber’s probe. [Table/Fig-3a,f]: Preoperative IOPA radiograph and picture, recall IOPA radiograph and picture b) one month, c) six months, d), g)one year demonstrating 3mm probing depth, e), h)one year six months.
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Sep 23, 2024
Dr Anil Dhingra 
Open Access