Dentaltown January 2025 - 39

CASE
4
Lateral lesion without a periapical lesion
As in the previous cases, a tooth with a lateral
radiolucency and a narrow deep probing defect
doesn't always have a vertical root fracture. This
presentation is often a chronic apical abscess draining
through the gingival sulcus. When there is no periapical
lesion, or when the lateral lesion is not continuous with the
periapical lesion, a chronic apical abscess may be less likely.
The patient in this case presented for a second opinion
after their dentist recommended extraction because of
a VRF. There was no periapical lesion, but a very distinct
and elongated midroot lesion was present. Exploration, or
scouting, with a small, curved stainless file revealed that a
large untreated lateral canal was responsible for the lateral
pathosis. When the accessory anatomy was located and
treated, the disease healed and the tooth was saved.
Fig. 15: Preop PA.
Fig. 16: Preop CBCT.
CASE
5
Bilateral lesions
This patient was very worried that she was
going to lose her front tooth, #8. Her dentist
was concerned that the root had been split
by a large, tapered post given the context of the bilateral
radiolucencies located at the bottom of the post.
No crack was seen when the post was removed,
nor were any lateral canals located. This tooth
was treated in three visits over six months using
a calcium hydroxide intracanal medicament. It is
possible that a nidus of bacteria remained in the gap
between the obturation and the post.
The patient's symptoms resolved after the first
visit. The case was obturated after confirming full
bony healing. She is still extremely appreciative of
the efforts made to save her front tooth.
Fig. 19: Preop PA.
Fig. 20: Preop CBCT.
Fig. 17: Lateral.
Fig. 18: Recall CBCT.
Fig. 21: Recall PA.
Fig. 22: Recall CBCT.
CASE
6
A lateral canal
Furcal lesions are generally caused
by furcation or lateral canals. However,
sometimes furcation lesions
can arise from VRF and result in extraction.
These fractures can occur anywhere, but
often follow the grooves in occlusal anatomy.
So when a furcation radiolucency is seen,
it is prudent to investigate its etiology and
not just extract it under the assumption of a
vertical root fracture.
Cases with lateral canals that extend from
the pulpal floor into the furcation can be
difficult to treat. Disinfection using sodium
hypochlorite is critically important, as is a
long soak. A calcium hydroxide intracanal
medicament
should be packed
into the floor of
the pulp chamber
between
appointments.
Sometimes, it
is possible to locate the lateral canals and
negotiate them with small, curved stainless
steel files. If a lateral canal is not disinfected,
ongoing symptoms and eventually
a furcal lesion of endodontic origin can be
expected. After NSRCT has been completed,
an adhesive liner or buildup can be placed
on the pulpal floor to prevent bacterial
reentry.
Fig. 23: Preop PA.
JANUARY 2025 | 39 | DENTALTOWN.COM
Fig. 24: Lateral canal.
Fig. 25: Postop PA.
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Dentaltown January 2025

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