Patient History & Chief Complaint

A 31-year-old patient presented with severe, sharp pain in the upper left posterior region, especially on chewing and pressure. Previous treatment done at another clinic included an RCT in 25 and a filling in 26.

Clinical & Radiographic Findings

  • Tooth 26 tender on vertical percussion
  • A dislodged restoration wedged between 25 & 26, impinging on the gingiva
  • IOPA X-ray showed
  • Tooth 25 – RCT completed
  • Tooth 26 – restoration close to pulp, secondary caries present
  • Dislodged restoration visible interproximally
  • Mild periapical radiolucency at root apex of 26

Treatment Plan

  • Non-surgical RCT in 26 over multiple sittings
  • Use of Calcium Hydroxide intracanal medicament due to periapical involvement
  • Final crown placement after completion of endodontic treatment

Procedure

First Sitting

  • The previous restoration partially removed
  • Local anesthesia administered
  • Access opening done all canals located
  • Working length determined (apex locator + X-ray)
  • Biomechanical preparation started with rotary files
  • Irrigation with saline + NaOCl
  • Canals dried; Calcium Hydroxide ICM placed
  • Temporary filling given

Second Sitting (1 week later)

  • Patient reported pain reduction
  • Temporarily removed; canals re-irrigated and re-instrumented
  • Fresh Calcium Hydroxide was placed

Third Sitting

  • Final irrigation with saline + NaOClO
  • bturation done with GP and sealer

Outcome

  • The tooth became asymptomatic post-obturation
  • Patient advised for final crown placement on 26
  • Prognosis considered good with timely RCT

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