Root Canal Treatment and Crown Preparation for Cracked Upper Right First Premolar (#14)
Root Canal Treatment
Root Canal on Premolar
Chief Complaint
Patient reported severe throbbing pain on the upper right side, worsening when lying down. Pain only partially relieved by Panadeine and Naproxen previously prescribed. Patient also tried Arcoxia 120 mg, which provided shorter relief. Pain started after biting on hard food during dinner two days ago and has progressively worsened.
Clinical Findings
Tooth #14: Very tender to percussion, positive bite test, positive transillumination, mobility and probing depth within normal limits. Cracked tooth with pulpal involvement.
Tooth #15: Possible shallow crack, very slight tenderness to percussion, negative bite test, equivocal transillumination.
Tooth #16 and #17: No tenderness to percussion or palpation.
Radiographic (CBCT): #14 with periapical lesion and widened PDL space.
No signs of maxillary sinusitis or shifting pain; symptoms localized to #14.
Treatment Plan
Root canal treatment (RCT), post-core, and crown for #14.
Extraction and immediate implant placement was discussed as an alternative, but patient chose RCT.
Risks, procedures, and success rate (85–95%) explained.
Informed consent obtained for RCT #14.
Pre-operative Assessment
CBCT confirmed periapical lesion and pulpal involvement.
Medical history and medications reviewed.
No contraindications for local anesthesia.
Anesthesia
Local anesthesia administered.
Rubber dam isolation achieved.
Patient prepared and draped under sterile conditions.
Surgical Procedure
Procedure (Root Canal Treatment #14)
Access cavity prepared under magnification (×10).
Caries and fracture lines fully cleared.
Canals located, negotiated, and working lengths established with apex locator:
Buccal canal: 17.5 mm
Palatal canal: 17.0 mmCleaning and shaping completed to #35 with irrigation using EDTA, hydrogen peroxide, and Milton’s solution.
Canals dried and obturated via vertical condensation and molten gutta-percha backfill.
Prefabricated and pre-tapered master GP cones with Kerr sealer used.
Fiber-reinforced composite resin (shade A2) placed as core build-up.
Occlusion adjusted and finishing completed.
Crown Preparation
Tooth #14 prepared for full coverage crown.
Upper and lower full-arch scans and occlusion digitally recorded.
Shade selected: 3M2.
Temporary crown provided.
Post Operation Gallery
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Post-operative Assessment
CBCT confirmed periapical lesion and pulpal involvement.
Medical history and medications reviewed.
No contraindications for local anesthesia.