Emergency Endodontic Treatment #31

An 80-year-old patient presented for an emergency examination with 9/10 pain associated with a tooth demonstrating a large periapical radiolucency on radiographic examination. Clinical and radiographic findings indicated endodontic involvement, and root canal therapy was recommended.

The patient returned the following day for treatment. Upon access and instrumentation of the distal canal, significant purulent drainage was encountered and persisted despite irrigation. Due to the active infection and continued drainage, definitive obturation was deferred. The canals were thoroughly irrigated and medicated with calcium hydroxide, and the tooth was temporized with a layered seal using cotton, Cavit, and IRM. Amoxicillin/clavulanate (Augmentin) was prescribed based on the patient's clinical presentation, and the patient was scheduled for reevaluation.

At the one-week follow-up, the patient's symptoms had resolved and the tooth was clinically appropriate for completion of treatment. Root canal therapy was finalized, followed by preparation of the tooth for a full-coverage crown to provide definitive coronal protection and long-term restoration.

The patient left the appointment pain-free, with the acute endodontic infection successfully managed and the tooth retained for definitive restoration.