A 14 year old female presented with parents for root canal treatment # 29. She had her braces removed recently and noticed a large, buccal swelling.
# 29 (+)perc, (+)palp, buccal swelling, no response to cold, (+)periapical lesion
- Apical diagnosis
- acute apical abcess
- Pulpal diagnosis
- necrotic
Treatment was completed in two visits. The goal of the first visit was to get the patient out of pain, I slightly instrumented and irrigated the canal; I placed calcium hydroxide and temporized with cotton pellet and cavit.
On the 2nd visit, she came back two weeks later, her swelling was gone and she was feeling better. We finished the case and the patient was very happy.
Some interesting facts:
The interesting factor was that apex was open and the tooth was necrotic. These are sometimes hard to manage because we don’t want to push our filling materials past the apex. I performed a procedure where I placed 3 mm of BC putty apically and then filled the rest of the canal with bioceramic sealer and Gutta Percha. I was happy that the material was contained and wasn’t pushed outside the apical segment. In order to contain the material, I always take a radiograph with a file and obtain my working length