Atypical healing of an endodontic lesion following emergency treatment: a case report

This case report examines the atypical healing of an endodontic lesion without standard endodontic treatment, influenced by the patient's failure to attend treatment appointments. A 50-year-old woman with no notable medical history presented with a deep carious lesion on her mandibular right first molar, accompanied by localized pain. Citing forgetfulness as a reason, the patient missed her initially scheduled root canal treatment, necessitating an emergency intervention. The emergency treatment included access cavity preparation, irrigation with 5.25% sodium hypochlorite solution, application of a modified triple antibiotic paste (equal parts penicillin G, metronidazole, and ciprofloxacin), and temporary restoration with amalgam. A large apical lesion was detected in immediate postoperative radiographs. However, the patient failed to return for definitive endodontic treatment, due to a lack of symptoms and time for treatment. Follow-up examinations 1 and 5 years after emergency treatment disclosed gradual healing of the lesion, culminating in the establishment of a normal periodontal ligament. This case underscores the potential efficacy of a modified triple antibiotic paste and highlights the importance of a well-sealed coronal restoration in promoting the healing of endodontic lesions, even in the absence of pulpectomy and conventional root canal therapy. Additional research is needed to understand the mechanisms behind such healing events.