REMOVAL OF CARIOUS LESION

INITIAL SITUATION

The patient presents with a dull pain localized in the right submandibular area. A clinical examination reveals the presence of a crown and an endocanal post on tooth 4.6 (lower right first molar) with gingival recession. Upon percussion, the tooth is symptomatic, causing painful stimuli.

A radiographic examination of the right mandibular area highlights the presence of a periapical granuloma and a carious infiltration beneath the old crown of tooth 4.6.

OBJECTIVE

Remove the old crown and the endodontic post to expose the underlying carious lesion for complete removal.

TREATMENT

In this clinical case, the tooth is non-vital with an old root canal treatment that appears radiographically inadequate, as the endodontic material does not fully fill the root canals. This suggests the presence of residual pulp and bacteria.

After removing the carious lesion, a rubber dam is placed to isolate the operative field from saliva and surrounding soft tissues.

During the root canal therapy, the old material inside the canals is removed.

A follow-up radiograph is then taken to verify the exact length of the root canals and ensure they have been thoroughly cleaned up to the root apex.

To prevent new bacterial colonization and keep the canals clean and disinfected, the root canals are sealed using gutta-percha cones and a specialized endodontic cement.

After sealing the root canals, the tooth structure is rebuilt using posts, followed by the fabrication and placement of a definitive zirconia crown.

Six months after the root canal treatment, a follow-up radiograph is taken to assess the resorption of the periapical granuloma.

MEDICAL CONSIDERATIONS

A thorough radiographic evaluation is essential during root canal treatment to identify any pre-existing complications and guide the procedure. The use of a rubber dam ensures proper isolation of the operative field, while the complete removal of old materials and thorough cleaning of the root canals are crucial for eliminating bacterial and pulp residues.

Sealing the canals with appropriate materials, such as gutta-percha cones and endodontic cement, prevents reinfection. The coronal reconstruction, using posts and a definitive crown, restores the functionality of the treated tooth.

Long-term follow-up is essential to assess the effectiveness of the treatment over time and prevent potential complications.