CASE HISTORY/EXAMINATION
A 28-year-old male reported to the Department of Conservative Dentistry
and Endodontics at our Institute with a chief complaint of spontaneous
tooth pain in the left posterior maxillary region for the past five
days. He informed that the pain worsened during sleep. The patient had
experienced intermittent pain in the upper left maxillary first molar
over the previous two months, triggered by hot and cold stimuli. Six
days prior, a general dentist had initiated root canal treatment on the
tooth, but the patient experienced no relief.
The patient’s medical history was insignificant. His Intraoral
examination revealed a temporary restoration in the upper left first
molar with tenderness on percussion. Periodontal probing showed that the
tooth was non-mobile and exhibited normal physiological function. The
vitality tests performed using heated gutta-percha (Dentsply Maillefer,
Ballaigues, Switzerland) and Endo-Frost (Coltene, USA), elicited severe
pain that lasted for over a minute. Adjacent teeth responded normally to
these tests.
A preoperative intraoral periapical radiograph (IOPA) revealed a
restoration involving the pulp and periodontal ligament widening in both
the mesiobuccal and distobuccal roots (Fig. 1a). The IOPA did not show
any unusual canal morphology. Based on clinical and radiographic
findings, a diagnosis of symptomatic irreversible pulpitis with
symptomatic apical periodontitis was made.