Figure legends
Fig. 1 Intraoral photographs and dental radiographs at the first visit.
(A) Intraoral photograph at the first visit. Redness and swelling are observed at the labial gingiva around #9 and #25. #25 has the sinus tract (black arrow). (B) Sinus tract tracing with a gutta-percha point. (C) Radiographic view showing the gutta-percha point from the sinus tract ending at one-fourth of the root length from the root apex of #25. White arrow; #25. (D) Dental radiographs of the orthoradial projection and eccentric projection. No cemental tear is observed at the root of #25. White arrow; #25.
Fig. 2 CBCT images of #25 at the first visit.
(A) Sagittal reconstructed CBCT images at the point of the distal, central, and mesial sides. Arrowhead: cemental tear. (B) Coronal reconstructed CBCT images at the point of a-f slice lines in Fig. 2A. Arrowhead: cemental tear. (C) Three-dimensional reconstruction of CBCT images.
Fig.3 Periodontal regenerative therapy with rhFGF-2.
(A) Presurgical view. (B) Single-flap approach with labial access. (C) After removal of granulomatous tissue. Cemental fragments (black arrows) are observed. (D) Methylene blue dye staining shows the cemental tear clearly. Then, granulomatous tissue is completely removed by the curette. (E) Labial view after the removal of the cemental fragment. (F) Occlusal view after the removal of the cemental fragment. (G) Application of rhFGF-2. (H) After suture. (I) Removed cemental fragments. (J) Removed granulomatous tissues.
Fig. 4 Histological examination of the removed cemental fragments.
(A) A low-power view of a cemental fragment shows the presence of mainly acellular cementum. HE staining. Scale bar: 500 μm. (B) Higher-power view of the open square (a) in Fig. 4A. Periodontal fibrous connective tissue (asterisk) is observed on the cemental fragment. HE staining. Scale bar: 50 μm. (C) Higher-power view of the open square (b) in Fig. 4A. Gram-positive bacterial colonies are observed (black arrows). Gram staining. Scale bar: 20 μm. (D) Higher-power view of the open square (b) in Fig. 4A. PAS-positive bacterial colonies are observed (black arrowheads). PAS staining. Scale bar: 20 μm.
Fig. 5 Histological examination of the removed granulomatous tissue.
(A) A low-power view of the granulomatous tissue. Dense fibrous tissue contains small, scattered cemental fragments (white arrows). HE staining. Scale bar: 500 μm. (B) Higher-power view of the open square in Fig. 5A. Cemental fragments within removed granulomatous tissue (white arrows). HE staining. Scale bar: 50 μm. (C) Higher-power view of the open square in Fig. 5A. Gram-positive bacterial colonies are observed within the cemental fragment (black arrows). Gram staining. Scale bar: 20 μm. (D) Higher-power view of the open square in Fig. 5A. PAS-positive bacterial colonies are observed within the cemental fragment (black arrowheads). PAS staining. Scale bar: 20 μm.
Fig. 6 Dental radiograph and intraoral photograph of #25 two years after the surgery.
(A) Dental radiograph. No abnormal findings. (B) Intraoral photograph. Clinically healthy soft tissue.
Fig. 7 CBCT images of #25 2 years after the surgery.
(A) Sagittal reconstructed CBCT images at the point of the distal, central, and mesial sides. Small arrows: bone regeneration. Arrowheads: labial bone level. Large arrows: lingual bone level. (B) Coronal reconstructed CBCT images at the point of a-f slice lines in Fig. 7A. Small arrows: reconstruction of the proximal bone and the labial bone. (C) Three-dimensional reconstruction of CBCT images.