Dental Tribune United Kindom Edition

17Endo TribuneJuly 30 - August 5, 2012United Kingdom Edition tent of the lesion, which ap- peared to involve the floor of the nasal sinus. The history of repeated palatal and buccal abscesses suggested a through - and through osseous defect. The diagnosis was apical peri- odontitis in tooth #9. The following treatment options were considered: • decompression combined with RCT; and • surgical removal of the le- sion with RCT on tooth #9 and possibly teeth #8, 10 and even 7 and 11 owing to the great risk of damaging nervous and vascular supply during sur- gery. The patient preferred the most conservative approach and treatment was performed in four appointments over five months. Management sequence 1 During the first visit, the previous root-canal fill- ing (gutta-percha with a plas- tic carrier) was removed (Fig 5). There was a lot of gutta- percha in the pulpal camera. This and remains of necrot- ic pulpal tissue could have been the cause of the brown staining of the tooth. Persis- tent purulent content from the canal was noted. A Ca(OH)2 paste (Ultracal XS, Ultradent) was placed in the root canal as interim medi- cation (Fig 6). Once the buc- cal encapsulated tissue was removed (Fig 7), copious drainage was also obtained from the buccal abscess. 2 After one month, Ca(OH)2 was replaced be- cause the canal could not be dried even after shaping and cleaning with copious amounts of 5.25 per cent so- dium hypochlorite. A vestibu- lar incision was made and a page 18DTàFig 5 Previous root-canal filling (gutta-percha with a plastic carrier) Fig 6 Ca(OH)2 root dressing ‘There is wide- spread agreement that most granulo- mas heal after non-surgical root- canal treatment (NSRCT), but there is no consent regarding this in the case of peri- apical cysts’