Patient: (60-year-old female) Tooth Involved: Maxillary right 1st premolar (#14) Main Complaint: Persistent pain and sensitivity in the upper right premolar
Clinical Examination
Patient visited our clinic with pain in her upper right premolar. Upon examination, tooth #14 was:
- Rotated (palato -mesially positioned)
- Severely abraded, exposing underlying dentin and even pulp
- Showing signs of chronic pulpitis
Diagnosis
After thorough clinical and radiographic evaluation, the diagnosis was:
- Chronic Pulpitis due to mechanical trauma and wear
- Severe occlusal abrasion with pulp exposure
- No periapical radiolucency (early intervention was timely)
Treatment Plan
We aimed to save the natural tooth using a conservative yet effective approach:
- Root Canal Therapy (RCT) to eliminate pain and remove infected pulp
- Direct Composite Restoration to rebuild the lost tooth structure and restore aesthetics and function.
Step-by-Step TreatmentStep
1: Root Canal Treatment
- Access cavity prepared through the rotated crown
- Canals located and cleaned using rotary endodontic files
- Irrigation with NaOCl and EDTA to disinfect canals
- Obturation done with gutta-percha and sealer
- Temporary filling placed until full healing
Step 2: Composite Build-Up
- Rubber dam isolation ensured a moisture-free field
- Tooth cleaned and conditioned
- Bonding agent applied, followed by incremental composite layering
- Tooth anatomy carefully restored to match natural contours
- Final polishing and occlusal adjustment completed
Final Outcome
- The patient experienced complete relief from pain
- The restored tooth looked natural and functioned well
- Occlusion was balanced and the bite re-established
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