Chief Complaint:

The patient presented with a complaint of pain in the lower left back tooth region, specifically around the area of tooth #37. The pain was localized and persistent, leading to discomfort, especially when chewing or applying pressure to the affected area.

Medical History:

The patient has no significant past medical history (NRMH) that would affect dental treatment. No systemic conditions were noted that would complicate the management of this case.

Clinical Examination: Upon clinical examination, the following findings were observed:

  • Resorted Teeth: Tooth #37 had a resorted crown, indicating that it had undergone previous restorative treatment.
  • Tenderness on Percussion: When gentle pressure was applied to tooth #37, the patient experienced tenderness, which is a key sign of inflammation or infection in the tooth's surrounding tissues.

These findings raised a concern for underlying infection or complications at the root level.

Radiographic Examination: A periapical radiograph of tooth #37 revealed several key findings:

  • Short Obturation: The radiograph showed that the root canal obturation was incomplete, with a short filling that did not extend to the apical region of the root. This could be a contributing factor to the persistent symptoms.
  • PDL Widening: There was evidence of periodontal ligament (PDL) widening around the root apex of tooth #37. This widening is commonly seen in cases of apical periodontitis, suggesting inflammation or infection at the tip of the root, which may lead to chronic apical periodontitis.

Diagnosis: Based on the clinical and radiographic findings, the diagnosis for this case is Chronic Apical Periodontitis associated with a previously treated tooth (tooth #37). The short obturation and PDL widening indicate that the initial root canal therapy was not adequately performed or has failed over time, resulting in an ongoing inflammatory process around the root.

Chronic apical periodontitis is often the result of an incomplete root canal treatment, allowing bacteria or irritants to persist in the root system and cause prolonged inflammation of the surrounding tissues.

Treatment Plan: The treatment approach for this case involves Root Canal Retreatment (ReRCT) of tooth #37. Here's how the process will be carried out:

  1. Removal of the Existing Filling: The existing root canal filling will be removed, and any remnants of old materials or infection will be thoroughly cleaned out from the root canals.
  2. Cleaning and Shaping of the Canals: The root canals will be cleaned, disinfected, and reshaped to ensure they are free from any bacteria or debris.
  3. Re-obturation: Once the canals are properly cleaned and prepared, a new, complete root canal filling will be placed to seal the tooth and prevent any further infection.
  4. Follow-up Radiographs: Post-treatment radiographs will be taken to ensure that the root canals are adequately filled and that there is no remaining infection at the root apex.
  5. Restorative Considerations: Depending on the outcome of the Retreatment and the health of the tooth, further restorative work may be necessary to restore the tooth to its functional state. This might involve placing a new crown or filling.

Prognosis: With proper root canal retreatment, the prognosis for tooth #37 is generally good. The key to success lies in completely removing any infection and filling the root canals properly to prevent recontamination. The surrounding bone and tissues typically heal after the infection is addressed, and the tooth can be retained in the mouth for many years.

Conclusion: Chronic apical periodontitis is a common condition resulting from incomplete or failed root canal therapy. Retreatment is a vital procedure for saving teeth that are suffering from ongoing infection or inflammation. In this case, the careful and thorough retreatment of tooth #37 will hopefully resolve the issue and restore the patient's comfort and oral health.

Patients with similar issues should seek professional dental care to address any symptoms promptly, as early intervention can prevent further complications and preserve natural teeth.

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