Pre-operative
- Tooth: Immature lower first molar with considerable caries under a failing restoration.
- Radiograph: Shows wide-open apical foramina on both roots and a periapical radiolucency.
8 months – Ca(OH)₂[^5]
- Procedure: After cleaning and shaping the canals (being careful of the open apices), the tooth was dressed with calcium hydroxide (Ca(OH)₂).
- Observation: Healing is progressing, but slowly. The radiograph shows that the Ca(OH)₂ paste has partially washed out, highlighting the need for regular changes.
- Protocol: It is advocated to change the Ca(OH)₂ dressing every three months to ensure its continued efficacy and to reassess the tooth.
18 months – Ca(OH)₂[^6]
- Observation: Significant periapical bone repair is evident.
- ==Clinical test: A hard tissue barrier at the apex is confirmed by gently probing with a fine paper point, which comes to a
Recall 2.5 yrs[^7][^8]
- Outcome: The root canal filling was completed. The gutta-percha appears short of the radiographic apex, but this is because a hard tissue barrier formed at that level, followed by some further root development.
- Conclusion: The tooth is stable and has been successfully restored. The case history is crucial to correctly interpret the final radiograph.