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Patient Yezhova L.I. aged 65

Patient Yezhova L.I. aged 65

Applied to our center in March 2013 with a basal cyst in tooth 43 after a series of consultations in the leading dental centers of Moscow. There she was recommended to remove tooth 43 and a number of other teeth. Unsatisfied with the offered treatment the patient came to us.

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OPG 1. Yezhova L.V., 65. Cystic cavity under tooth 43.

When the patient firstly applied to "NANO-DENT" her case was diagnosed as periapical cyst of root 43 and exacerbation of chronic granulating periodontitis (fistula). It was decided for a conservative treatment. Cystic cavity under 43 was treated through the root canal as well as through the fistula. Root 43 was covered with dental dressing.

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Photo 1. The fistula under tooth 43 was cleared of pus and treated with microinstruments with shape memory effect. Nanostructured hydroxyapatite gel (NHAG) enriched with silver was injected into the cavity and fistula.

IOPAR of 43 showed that due to gravity NHAG was localized mainly in the bottom of the cavity.

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IOPAR 43: NHAG conglomerates.

In the course of conservative treatment NHAG with nanosilver was repeatedly applied through the root canal.

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IOPAR 43: NHAG has integrated with the bone. Regenerated bone demonstrates increased density as compared with that of organotype. Tne cyst was resolved.

Repeated OPG revealed a distinct tendency towards the replacement of cystic cavity by the healthy bone tissue.

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OPG 2. After two months of treatment the cavity under 44 decreased in size, NHAG integrates with the surrounding bone.

A silver post-and-core was placed within root 43, to be followed by the fixation of metal ceramic bridge.

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Photo 2. A silver post-and-core was affixed within the root of tooth 43. In place of the missing tooth 46 a shape memory implant was inserted (the abutment is shown) and a silver post-and-core was placed within the root of tooth 47. Later a metal-ceramic bridge was fixed on teeth 43, 44 with the dental implant in place of tooth 46.

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Photo 3. Just after fixation of the metal ceramic bridge.

OPG taken after the prosthetics was completed confirmed the positive result of treatment. The patient is under dynamic preventive supervision.

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OPG 3. NHAG has got integrated with the bone, regenerated bone shows increased density. Nidus of localized osteoporosis induced by growth of the cyst 43 was replaced by the bone. Periodontium of tooth 43 was saved.

IOPA radiography in October 2013.

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IOPAR 43. Six months after the beginning of treatment NHAG got integrated with the bone, forming regenerated bone of increased density. The cyst was eliminated.

The patient also objected to the previously recommended extraction of the roots 36 (left lower molar). Roots 36 were destroyed under the level of gingiva which has grown into them (granulation). After removal of the crown from tooth 36 cysts were revealed under the roots alongside with the missing bone between them. On the gingiva,in the projection of roots 36, there was a fistula with purulent discharge (Photo 4).

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Photo 4. Granulations in roots 36. Fistula under the front root 36.

The presence of cysts was confirmed by the roentgenogram.

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Roentgenogram of 36. Cysts under both roots. Vertical defect of the posterior root mesial surface.

To eliminate the cysts and to disinfect the space between roots 36 silver-enriched NHAG was placed in cysts through and between roots 36.

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Roentgenogram of 36. In a month after the beginning of treatment. NHAG has concentrated within the defects of roots 36.

Then hemisection (separation) of roots 36 was performed (Photo 5).

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Photo 5. Roots 36 are separated.

After cysts were eliminated silver post-and-cores were made.

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Photo 6. Side view of post-and-cores.

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Photo 7. Post-and-cores in 36. View from above.

Roentgenogram of 36 shows the absence of cysts under roots 36. Post-and-cores are fixed on antibacterial intermetallide composite.

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Roentgenogram of 36. Post-and-cores are fixed.

Then post-and-cores in roots 36 were combined by a metal ceramic crown (Photos 7 and 8).

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Photo 7. Side view of the crown.

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Photo 8. Metal ceramic dentures in place of tooth 36 and teeth 43-47. View from above. The patient made a written comment on the results of treatment - Patients’ comments