Patient Complaint
A patient reported to our clinic with a swelling in the upper left back tooth region, specifically in the area of tooth 26 (upper left first molar). The swelling had been present for several days, and the patient complained of discomfort while chewing.
Clinical & Radiographic Examination
Tooth 26 was already restored with a full-coverage crown, but showed signs of tenderness on percussion. A radiographic examination revealed a periapical lesion associated with the mesial root, indicating a possible failure of previous root canal treatment.
Diagnosis
Based on the clinical signs and radiographic evidence, the diagnosis was a chronic periapical abscess secondary to failed RCT, with gingival overgrowth likely due to chronic inflammation and poor plaque control. A treatment plan was formulated to address both the endodontic infection and the soft tissue enlargement.Diagnosis
Treatment Protocol
1. Crown Removal and Re-RCT Initiation:
- The existing crown was carefully removed to access the tooth structure.
- A re-root canal treatment (Re-RCT) was initiated.
- The canals were cleaned thoroughly, and intracanal
- medicament (ICM) was placed to disinfect the infected root canal system.
2. Periodontal Management:
- Full mouth scaling was performed to control plaque and reduce inflammation.
- The gingival overgrowth near the tooth was excised using a soft tissue laser, ensuring a bloodless and precise removal with faster healing.
3. Healing Phase & Follow-up:
- The patient was kept on a 2-week follow-up to monitor soft tissue healing and ensure the infection was resolving.
- The swelling had subsided, and the gingiva returned to a healthy, pink state.
4. Completion of Treatment:
- After confirming satisfactory healing and reduction of symptoms, obturation of the root canals was done.
- The tooth was restored again with a new full-coverage crown, re-establishing function and aesthetics.
Final Outcome
The treatment resulted in complete resolution of the swelling, healthy gingival architecture, and elimination of the periapical infection. The patient was comfortable and satisfied with both the function and appearance of the restored tooth.
Takeaway
This case highlights the importance of thorough diagnosis and integrated dental care. Re-RCT combined with periodontal therapy and laser-assisted soft tissue management can effectively salvage compromised teeth and restore oral health.
If you're experiencing swelling near a previously treated tooth or notice gum overgrowth, consult your dentist immediately. Timely intervention can save your tooth and prevent further complications.