Patient Presentation:

The 15 years old female patient, reported experiencing persistent pain in the lower right back tooth region. The pain was described as sharp and throbbing, particularly noticeable when chewing or applying pressure to the affected area. The discomfort had been ongoing for several days, and the patient was concerned about the worsening intensity of the pain. No significant medical history was reported that could be contributing to the dental issue.

Clinical Examination: 

Upon examination, the patient showed signs of localized swelling and tenderness upon palpation around the right mandibular second molar (tooth number 47). There was no significant mobility of the tooth, but the tooth was sensitive to both percussion and thermal tests, which indicated a possible pulp involvement. The surrounding gums appeared mildly inflamed.

Diagnosis: 

Based on the clinical signs and symptoms, along with radiographic imaging, the diagnosis was confirmed as Symptomatic Irreversible Pulpitis (SIP) with Chronic Apical Periodontitis (CAP) affecting tooth number 47.

  • Symptomatic Irreversible Pulpitis (SIP): This condition suggests that the pulp of the tooth (the innermost tissue) is inflamed, causing pain that is often spontaneous or triggered by stimuli like hot, cold, or chewing. The inflammation is irreversible, meaning the pulp is damaged beyond repair and requires root canal therapy to save the tooth.
  • Chronic Apical Periodontitis (CAP): The radiograph showed periapical radiolucency at the root apex, indicating chronic infection or inflammation at the tip of the tooth root. This condition can develop after untreated or inadequately treated pulpitis, leading to an infection of the surrounding bone and tissues.

Treatment Plan: The treatment plan was carefully outlined as follows:

Root Canal Treatment (RCT):

  • Objective: The primary goal of RCT was to remove the infected or necrotic pulp tissue from the tooth. This would prevent further infection and relieve the patient’s pain.
  • Procedure: After local anaesthesia to ensure patient comfort, an access cavity was created on tooth 47. The infected pulp tissue was removed, and the root canals were thoroughly cleaned and shaped. The canals were then filled with biocompatible material (gutta-percha) to seal them, preventing future infections.

Endocrown Restoration:

  • Objective: Following the successful completion of the root canal therapy, the next step was to restore the structural integrity of tooth 47, which had been weakened due to extensive pulp and tissue loss.
  • Procedure: An endocrine was chosen as the ideal restorative option. An endocrown is a type of dental crown that is specifically designed for teeth that have undergone root canal therapy. Unlike traditional crowns, an endocrine is bonded directly to the tooth structure and covers both the crown and the end of the tooth. This offers greater retention, especially for posterior teeth that experience significant chewing forces.
  • The preparation involved shaping the tooth and taking precise impressions. The final endocrown was custom-made in the dental laboratory and placed on the tooth with a strong adhesive to ensure stability and durability.

Outcome and Follow-up:

Post-treatment, the patient reported immediate relief from the pain, and the tooth was functional once again. The inflammation around the tooth subsided, and there were no signs of further infection. The endocrine provides the necessary protection and restoration of the tooth’s appearance and function.

The patient was advised to maintain regular follow-up appointments to monitor the healing progress and ensure that no complications arise. Proper oral hygiene practices were emphasized to prevent reinfection or further issues.

Conclusion:

This case highlights the importance of timely intervention for conditions such as Symptomatic Irreversible Pulpitis and Chronic Apical Periodontitis. Root canal therapy combined with an endocrine restoration provided a successful outcome, restoring both the function and aesthetic appearance of the affected tooth.

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