A 22-year-old male patient (Table 1; patient 10) was seen with the complaint of tooth mobility, tooth discolouration and loss of tooth substance of both maxillary central incisors. There was a history of a trauma 4 years previously with extensive crown fractures. Apical radiolucencies were present on teeth 11 and 21 (Fig. 8). No signs of an active fistula was seen. Endodontic treatment was started in tooth 11. The root canal was cleaned and shaped up to a MAF 100. Reogan-Rapid paste was introduced in the root canal. The paste was also unintentionally extruded into the periradicular region and into an undiagnosed sinus tract, entering the buccal fold. (Fig. 9). The excess of calcium hydroxide paste was removed using a moistened gauze and the soft tissues were vigorously rinsed with saline. Seven days later tooth 21 was cleaned and shaped up to a MAF 100 and a calcium hydroxide intracanal dressing was placed. As the sinus tract was still present, the root canal was thoroughly cleaned and copiously irrigated with sodium hypochlorite 2.5%. The dressing in tooth 11 was renewed. The patient returned after 10 months (due to postponement of appointments) and the permanent root filling of tooth 21 was performed (Fig. 10). As the sinus tract was still present, tooth 11 was cleaned and shaped up to a MAF 110 and a new calcium hydroxide dressing was placed. On the control radiograph, (Fig. 10) the apical radiolucency associated with tooth 21 had apparently disappeared. There was still an overextension of calcium hydroxide at the apex of tooth 11. One month later, the fistula was absent, though it was not possible to completely dry the root canal. A new calcium hydroxide dressing was placed. A diminished periapical radiolucency was seen on the control radiograph as well as the remnants of the calcium hydroxide paste (Fig. 11). The permanent root canal filling of tooth 11 was performed 1 year and 4 months after the first visit, again due to postponed appointments. Both apical radiolucencies had disappeared. The remnants of the more than 1-year old calcium hydroxide overextension were still present, but these remnants apparently did not disfavour apical healing (Fig. 12). The 2-year control radiograph confirmed healing of the lesion, with remnants of the calcium hydroxide paste still present (Fig. 13).
Figure 8. Detail of an intraoral radiograph, showing periradicular radiolucencies on both maxillary central incisors, with a history of untreated dental trauma.
Figure 9. Control radiograph of the calcium hydroxide dressing with unintentional periradicular overextension into the buccal fold through a sinus tract.
Figure 10. Control radiograph of the root canal obturation of tooth 21. As the sinus tract was still present, the calcium hydroxide paste was renewed in tooth 11. Due to postponement of appointments, there was a difference of 10 months between the first session (Fig. 8) and the present root canal fillings.
Figure 11. Control radiograph of another calcium hydroxide replacement 1 month after the previous 10 months appointment. There is still calcium hydroxide present in the periapex.
Figure 12. Control radiograph of the permanent root canal filling of tooth 11 and showing healed periapical lesions of both teeth 11 and 21. There are still remains of the previously overextended calcium hydroxide paste.
Figure 13. The 2-year control radiograph. The periradicular situation remains unchanged.