Patient Information
A patient reported with a history of a composite restoration in tooth 46 (lower right first molar). Initially, the filling was done because of deep caries approaching the pulp.
Chief Complaint
After about a week, the patient returned with severe pain in tooth 46, especially on chewing and at night.
Clinical & Radiographic Findings
- Tooth 46 was tender on percussion (TOP).
- Radiographic evaluation showed that the earlier restoration was very close to the pulp, and symptoms indicated irreversible pulpitis.
- Hence, a decision was made to perform Root Canal Treatment (RCT).
Treatment Procedure
Step 1: Access Opening & Cleaning
- Local anesthesia was administered, and rubber dam isolation was achieved.
- An access opening (RCO) was created in tooth 46.
- Biomechanical Preparation (BMP) was performed using rotary and hand instruments to thoroughly clean and shape the root canals.
Step 2: Intracanal Medication (ICM)
- To ensure proper disinfection, intracanal medicament was placed inside the canals.
- The tooth was sealed with a temporary restoration, and the patient was recalled after 2 weeks.
Step 3: Obturation
- At the follow-up visit, the patient was completely asymptomatic.
- The canals were dried and then obturated with gutta-percha to achieve a three-dimensional seal.
Step 4: Post-Endodontic Restoration
- A composite post-endodontic restoration was done to strengthen the tooth and provide coronal seal.
Step 5: Full Coverage Crown
- Since tooth 46 is a molar that bears heavy chewing forces, a full coverage cap (dental crown) was advised and delivered to prevent fracture and ensure long-term protection.
Why Did the Filling Fail?
When caries is very deep and close to the pulp, even after careful placement of a composite filling, the pulp may get irreversibly inflamed due to:
- Bacterial leakage or micro-exposure.
- Heat and pressure during cavity preparation.
- Patient’s pulp response and sensitivity.
In such cases, Root Canal Treatment becomes necessary to relieve pain and preserve the tooth.
Final Outcome
- Tooth 46 was successfully treated with RCT and restored with a permanent crown.
- The patient reported no pain or discomfort after treatment and could chew comfortably.
Key Takeaway for Patients
- A filling close to the pulp sometimes cannot save the tooth permanently. If pain develops later, RCT is the safest way to preserve the tooth.
- Post-root canal, a crown is essential on molars to prevent fracture and ensure long-term success.
If you have a deep cavity treated with a filling and still feel persistent pain, do not ignore it. Early root canal treatment can save your tooth and restore full function.