Endodontic intervention in mandibular premolar with complex anatomy associated to cracked root diagnosis: Case report

Érica da Silva Pinheiro Ruas, Rogério Vieira Silva, Renato Piai Pereira, Eduardo Nunes.

Introduction: Internal dental anatomy represents a great challenge in Endodontics. Diagnosing and delineating an accurate treatment plan is often a challenge. Objective: The objective of this case report was to describe a clinical case of endodontic intervention in mandibular premolar with complex anatomy, associated with cracked root after two and a half years. Case report: Female patient was referred for evaluation with painful symptoms. Clinical examination revealed tooth #44 provided support for a removable partial denture and was periodontally healthy. Active intraoral fistula was also present. Pulpal sensitivity tests were performed with negative response. Radiographic examination revealed complex dental anatomy, with two fused roots and periapical lesion. Diagnosis of pulp necrosis was established, and endodontic therapy instituted. Results: Clinical and radiographic control one year and four months later demonstrated repair of periapical region, as well as recovery of masticatory and aesthetic functions. However, two and a half years after endodontic intervention, the patient returned with painful symptoms. Examination revealed a periodontal pocket located 12mm mesiobucally, whereas radiographic examination evinced lateral apical periodontitis. Cone-beam computed tomographic scans were requested, but did not add to the diagnosis. Clinical signs established the diagnosis of cracked root with indication of extraction and referral for oral rehabilitation. Conclusion: The importance of diagnosis and follow-up as well as supremacy of clinical examination are highlighted for the implementation of the correct treatment plan.

Keywords: Root canal preparation. Endodontics. Tomography.

How to cite: Ruas ESP, Silva RV, Pereira RP, Nunes E. Endodontic intervention in mandibular premolar with complex anatomy associated to cracked root diagnosis: Case report. Dental Press Endod. 2017 Jan-Apr;7(1):78-84. DOI: http://dx.doi.org/10.14436/2358-2545.7.1.078-084.oar

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