Case
Root Canal Treatment at Upper Left First Premolar
Case presentation:
This lady was referred by a colleague, having pain, swelling and disturbed sleep from the upper left first premolar (UL4). Caries under the crown at UL4 was noted, alongside tenderness to percussion and a buccal swelling.
Diagnosis:
A diagnosis of pulp necrosis and acute periapical abscess was made.
Treatment:
At the initial appointment, the crown at UL4 was removed to assess restorability of the tooth.
Happily, plenty of dentine remained to restore, and access of the pulp chamber was initiated.
Due to the acute inflammation, full anaesthesia could not be achieved at this first appointment, and a pulpal dressing of non-setting calcium hydroxide was placed. A provisional crown was cemented to seal the tooth.
A second appointment was scheduled, and thorough chemo-mechanical preparation was completed with Protaper Gold nickel titanium files and finished to 30/.09. The two separate canals merged at 16mm to a single canal in the apical 3.5mm. Obturation was completed with taper matched gutta-percha cones, warm vertical compaction, and AH plus sealer.
The patient was pain and symptom free at the review appointment.