Reversible pulpal inflammation. Case after implant placement adjacent to algogenic tooth.
A patient was referred to the implant dentistry clinic with a complaint of constant, rapidly waning pain when swallowing cold liquids, located in tooth 34. The pain started one week after placing an implant adjacent to the tooth, three weeks earlier and the occlusal adjustment previously performed did not result in any improvement in the condition. On clinical examination, slightly exacerbated pain in said tooth compared to teeth 33 to 31. Radiographic and tomographic exams showed the implant in close contact with the apical region of tooth 34, but not touching it.
The patient was instructed to take analgesic (dipyrone) when there was pain and the removal of the implant was studied. At the return after one month, the pain had spontaneously ceased and the thermal test produced pain with the same intensity as the adjoining teeth.
It was assumed, therefore, that the reversible pulp inflammation was caused by an inflammatory process in the periapical region, and that when it evolved to repair, the inflammation in the pulp also disappeared.
The case alerts to the importance of careful observation of the causal factors of pulpal inflammation, and careful proservation, without haste, when there is no immediate need for urgent intervention.
Reversible pulp inflammation, when treated by the endodontic specialist, usually has causes that are more difficult to detect than the more common ones, such as caries and periodontal disease.
Many times the patient has already been to more than one dental surgeon, without a diagnosis having been pointed out and is already disillusioned and uncooperative during the process of searching for the cause. The most frequent ones are premature occlusal contacts, dental clenching, non-carious cervical lesions, poorly adapted removable prostheses, and harmful habits, among other less frequent ones. It is up to the professional to try to diagnose with patience and discretion. Many times the real cause is not discovered right at the beginning of the treatment.
