Diagnosis and treatment of teeth with primary endodontic lesions mimicking periodontal disease: three cases with long-term follow ups
A 43-year-old female patient visited our clinic because of intermittent discomfort of her right mandibular teeth. She had visited 2 other dental clinics, and both dentists recommended extraction of her right mandibular first molar because they believed the mesial root might be vertically fractured. Based on her prior dental history, #46 was pulpotomized several years ago and had maintained asymptomatic until 2 months ago. The tooth was sensitive to percussion and bite. There was no mobility, and periodontal probing was within normal limits. Large periapical lesions in both roots and a J-shaped alveolar bone defect in the mesial root were observed in the periapical radiographs (). A cone-beam computed tomography (CBCT, Pax-Zenith3D, Vatech, Yongin, Korea, 104 kVp, 5.5 mA) was also performed to rule out a vertical root fracture (). The tooth was diagnosed as a previously initiated tooth with chronic apical periodontitis. The possibility of vertical root fracture was explained to the patient, but we believed a primary endodontic lesion without any fractures was possible, so nonsurgical endodontic therapy was suggested as the first option.\nThe gold crown and amalgam core were removed. There was no visible crack or fracture line found on the outer and inner access cavity walls. Conventional root canal treatment was performed using a protocol similar to that described in case 1. Three canals were found and enlarged to a 0.04 taper of the #35 Profile (). At the second visit, the patient was asymptomatic, and the canals were clean. The canals were obturated, and a composite resin core was built (). At a 3-month follow up (), the patient was asymptomatic and sent to the department of prosthodontics for a crown restoration. The tooth underwent routine check-ups and was asymptomatic through a 2-year follow up ().