Sometimes, a tooth that already has a crown and root canal treatment may still develop infection. This can result in gum swelling, pus discharge, and discomfort. In such cases, retreatment is often the best solution to save the natural tooth. Here, we present the successful management of tooth 16 that developed infection beneath a crown.
Patient’s Chief Complaint
The patient reported
- Swelling in the gums near an already crowned tooth (tooth 16 – upper right first molar)
- Pain and discomfort while chewing
- Occasional pus discharge from the gums
Clinical & Radiographic Findings
- Gum swelling and sinus tract observed adjacent to 16.
- Radiograph revealed an infection associated with the root apex of tooth 16.
- Diagnosis Previously treated tooth with chronic periapical infection.
Treatment Procedure
1. Access Through Existing Crown
- The crown was preserved, and access opening was made through it.
- Old root canal filling was carefully removed to reach the infected canals.
2. Pus Drainage & Irrigation
- Upon access, pus discharge was noted.
- Thorough irrigation was carried out using sodium hypochlorite, saline, and EDTA to disinfect the canals.
3. Intracanal Medicament (ICM) Placement
- Calcium hydroxide was placed as an intracanal medicament for 2 weeks.
- This helped in eliminating bacteria and promoting periapical healing.
- The tooth was temporized, and the patient was recalled.
4. Obturation
- On the follow-up visit, the swelling had subsided, and no pus discharge was present.
- Root canals were dried and obturated using gutta-percha with sealer, ensuring a tight seal.
5. Post-Endodontic Restoration & Crown
- After successful obturation, the access cavity was restored with composite filling.
- Finally, a new crown was fabricated to reinforce the tooth and restore full function.
Outcome and Follow-Up
- Patient experienced relief from pain and swelling.
- The sinus tract healed completely.
- Radiographic follow-up showed signs of periapical healing.
- Tooth 16 was functional and esthetically restored with a new crown.
Key Benefits of Retreatment in Crowned Teeth
- Saves the natural tooth instead of extraction.
- Treats underlying infection thoroughly.
- Restores strength and esthetics with a fresh crown.
Key Takeaway
Even if a tooth with a crown develops swelling or pus discharge, endodontic retreatment with proper disinfection and medicament can save the tooth and restore it back to health.