A 6┐ root tip lesion had spread buccally, perforated the buccal bone, and formed a thin canal with an opening diameter of approximately 3.7 x 5.8 mm. Bleeding was observed from the distal root canal foramen, and the probing depth was within 3 mm. After root canal formation, EMAT was performed and the canal was filled immediately. Although there was a slight enlargement of the periodontal lumen on the distal side of the centorhombic root, the bone beam structure was homogenized, and a continuous alveolar hard line was observed, showing an almost normal image.

Normally, it is known that the thin hole will heal once appropriate root canal treatment is performed and the inflammation around the root apex disappears. However, when the bone wall defect is large, bone formation is insufficient and connective tissue invades the defect, resulting in some cases where bone defects remain on radiographs despite the absence of inflammation.

In this case, a large bone wall loss was observed on the buccal side, but bone formation was observed one month later, suggesting that the healing-promoting effect of EMAT may have been demonstrated.

A sinus tract, called a "thinning hole" in Japanese, is a canal through which pus accumulating around the root penetrates the gum and drains out.

Preoperative radiographs show black permeation and clear bone dissolution. (yellow line)

At first glance, it looks like a puckered pimple on the gum, but the bone has dissolved over 9.0 mm longitudinally, and the bone surrounding the tooth root, called the bone wall, has also been severely damaged.

It is said that the success rate of root canal treatment is 47.2% when the bone has dissolved more than 5.0mm. (Quoted from the following* paper)

This is also a widely used standard for tooth extraction in Japan.

The photo in C is a radiograph taken one year and five months after the EMAT procedure.

White bone regeneration can be seen in the areas that were black and permeable preoperatively, and bone wall restoration can also be seen.

In this case, the resorbed bone began to regenerate after about 3 months, showing the bone regenerative effect of EMAT.

An X-ray transmission image with a width diameter of approximately 26.5 mm was observed in the white tooth area on the right side of the mandible, and root canal treatment had been performed on 6┐. The electro pulp examination revealed that 7┐ and 5┐ did not show any signs of living reaction, so root canal treatment was performed on the three teeth according to the usual method. After removing the contaminated contents and dentin from the root canal, passive ultrasonic irrigation was performed using 2% sodium hypochlorite. The patient underwent passive ultrasonic irrigation using 2% sodium hypochlorite, and calcium hydroxide was applied three times, but there was no significant change in the findings in the root canal. Therefore, the 6┐ proximal root tip equivalent was dissected with a 5×5 mm full-layer valve, the buccal bone was perforated by approximately 3-4 mm, and EMAT was performed through the 65┐ root canal after a possible curettage of the cyst wall for the purpose of promoting bone formation. After 3 months, osteogenesis was already seen in the bone wall of the lesion, and after 2 years and 1 month, the bone trabecular structure was almost equal to that of the surrounding bone.

Although many reports indicate that the size of the lesion affects the success rate of treatment, we believe that the fact that the bone defect improved in 3 months may be due to the healing-promoting effect of EMAT, even though curettage of the cyst wall was also used in this case.

Preoperative radiographs show black transparency and a clear image of bone resorption. (yellow line). The area of bone resorption is 26.5 mm in width and diameter on the radiograph, and is so extensive that three teeth are completely covered. In addition, this case is a "root cyst," a condition in which the infection is not confined to the tooth but extends around the root, trapping pus and other substances in a pouch-like form.

In most cases, the tooth is extracted or a "root tip resection" is performed, in which the tip of the root is cut off and the bag of pus is removed. In this case, EMAT was performed after the usual root canal treatment for three teeth. Picture C is a radiograph taken 2 years and 1 month after the EMAT procedure. There is no effective nonsurgical treatment for root cysts. In this case, the resorbed bone began to regenerate in about 3 months after EMAT, and about 2 years later, the resorbed bone area, which was 30 mm in diameter, was regenerated.