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.