When a patient presents with pain in the posterior region, especially while chewing, it often signals an underlying dental issue that requires more than just a simple filling. In this case, a man in his thirties came to our clinic with discomfort in his lower left jaw. The focus of his treatment became not just pain relief, but also the long-term preservation of tooth structure and function, ultimately achieved through a Porcelain-Fused-to-Metal (PFM) crown.

Chief Complaint

The patient reported pain while chewing on the lower left side. The discomfort had been persistent for a few days and was progressively getting worse.

Clinical Examination and Diagnosis

Intraoral examination revealed that the mandibular left second premolar (tooth #35) had a dislodged restoration with visible secondary caries. The tooth was tender on percussion, suggesting inflammation of the pulp. There was no swelling, sinus tract, or mobility. Pulp vitality testing confirmed a diagnosis of irreversible pulpitis.

Treatment Plan

After discussing options with the patient, we proceeded with:

  • Single visit Root Canal Therapy (RCT) to eliminate infection and relieve pain
  • Full coverage restoration with a PFM crown to restore function, prevent fracture, and improve aesthetics

Root Canal Treatment (Brief Overview)

Under local anaesthesia, endodontic access was established. The canals were cleaned and shaped using rotary instruments with irrigation using sodium hypochlorite and saline. The canals were then obturated with gutta-percha and sealer. A composite core build-up was placed to prepare the tooth for crown placement.

Focus of the Case: Crown Fabrication and Placement

Tooth Preparation

  • A full metal ceramic (PFM) crown preparation was done on tooth #35. Reductions were made to accommodate the crown
  • All internal line angles were rounded to reduce stress points, and proper retention and resistance form were maintained.

Impression and Shade Selection

Following tooth preparation, an intraoral scan was performed to ensure precise digital impressions. Shade selection was done using the VITA shade guide, carefully matching the surrounding natural dentition for a seamless aesthetic blend.

Laboratory Phase

The digital scan and lab prescription were sent for fabrication of a Porcelain Fused to Metal crown. A metal coping was designed for strength, and layered porcelain was applied for natural looking aesthetics. Internal staining and final glazing were requested to closely match adjacent teeth.

Cementation

At the crown delivery appointment, several checks were performed:

  • Marginal fit and adaptation
  • Proximal contacts
  • Occlusion in static and dynamic movements

Once everything was verified and the patient was satisfied with the appearance, the crown was cemented.

Outcome and Follow-Up

The patient reported immediate relief from pain after the root canal procedure. On review, the crown was functioning well, with no discomfort or bite issues. Aesthetics were well received, and the tooth was fully restored in both function and appearance.

Conclusion

This case illustrates how essential full coverage restorations are after root canal treatment, particularly in posterior teeth that endure heavy occlusal forces. The PFM crown offered the ideal combination of strength, fit, and aesthetic value, ensuring long-term success for the treated tooth. With proper care, the restoration is expected to serve the patient reliably for many years.

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