When dental pain strikes during a brief visit home, quick action is essential. A recent patient came to our clinic with discomfort in the lower left back tooth region specifically, tooth #35, the lower left second premolar. The pain was triggered by chewing and had recently started occurring spontaneously as well. With limited time in the country, the patient requested a complete resolution before travelling again.

Initial Assessment: What We Found

Our clinical examination revealed some key issues:

  • The tooth was tender to percussion, indicating inflammation in the periapical area.
  • There was no swelling or sinus tract, which was a positive sign.
  • A deep carious lesion was evident on tooth 35.
  • The tooth had a previous restoration done a few years ago, but the filling had dislodged, leaving the tooth vulnerable.
  • Vitality testing returned a positive result, confirming that the pulp was still alive but likely inflamed.

Radiographic examination confirmed the clinical findings:

  • The caries had extended to the pulp.
  • The dislodged filling was clearly visible on the X-ray.

Diagnosis

Based on the findings, the tooth was diagnosed with symptomatic irreversible pulpitis. Given the patient’s tight schedule, we proposed a single-sitting root canal treatment (RCT) with immediate crown preparation and scanning for prosthetic restoration.

Treatment: One Visit, Complete Relief

Despite the time constraints, the entire procedure was planned and executed efficiently in a single appointment.

Step 1: Anesthesia & Isolation

  • Local anaesthesia was administered to ensure a painless experience.
  • Rubber dam isolation was used to maintain a sterile field.

Step 2: Access & Canal Preparation

  • A conservative access cavity was created to locate and negotiate the canal.
  • The working length was determined with an apex locator and confirmed radiographically.
  • Biomechanical preparation was done using rotary files, accompanied by copious irrigation with NaOCl, EDTA, and saline to disinfect the canal thoroughly.

Step 3: Obturation

  • The canal was dried and obturated using gutta-percha and sealer with either lateral or vertical condensation.
  • A post obturation radiograph confirmed proper fill and sealing of the canal.

Step 4: Crown Preparation & Digital Scanning

A post-endodontic build-up was done as needed.

The tooth was then prepared for a full coverage crown, and a digital scan was taken using an intraoral scanner for precision crown fabrication.

Results & Follow-Up

The patient experienced immediate relief from pain and was happy to have the procedure completed in a single sitting. Instructions were given regarding crown placement, which would either be completed locally or upon returning to their home country.

Conclusion

This case is a perfect example of how prompt diagnosis, efficient planning, and modern endodontic techniques can restore a severely compromised tooth in just one visit. Managing a symptomatic, previously restored premolar with a dislodged filling doesn’t have to mean multiple appointments a well executed single sitting root canal can be both effective and time-saving.

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