Endodontic urgency in a tooth with metal crown
The decision to remove or maintain a metal crown varies according to the choice and experience of each professional. In this case, we opted for access through the prosthesis, which facilitates the isolation and consequently the treatment itself.
Case conducted by student Marisa Yshii, from the endodontics specialization course at APCD Bragança Paulista.
Endodontic urgency In: Machado, Ricardo. Endodontics: Biological and Technical Principles. Grupo GEN, Grupo GEN, 2022.
Irreversible pulpitis
It is characterized by the occurrence of acute and persistent pain (30 seconds or more) after thermal stimuli, spontaneous (unprovoked) and/or referred, and may be accentuated after postural changes. The use of conventional analgesics is ineffective, and the commonly related etiologic factors are fractures, caries, or extensive and deep untreated restorations. When the patient is unable to recognize the tooth responsible for the pain process and the teeth in the region (including those in the opposite arch) also have caries or extensive and deep restorations, diagnosis becomes extremely difficult.
In certain cases, there may be a complete absence of clinical symptoms and the teeth respond normally to thermal tests. There may be a history of trauma, and clinically there may be deep caries, which in most cases results in pulp exposure during removal, absence of percussive and palpatory symptoms, and radiographically the peri-radicular tissues are unaltered.
The emergency treatment in cases of irreversible pulpitis is preferably based on the complete removal of the pulp tissue. If the professional does not have enough time or there is another factor that prevents him or her from proceeding with complete instrumentation of the root canal(s), partial pulpectomy (extirpation of the pulp from the cervical and middle thirds) of all canals (preferably) or at least of the largest canal should be performed.
Irreversible pulpitis
It is characterized by the occurrence of acute and persistent pain (30 seconds or more) after thermal stimuli, spontaneous (unprovoked) and/or referred, and may be accentuated after postural changes. The use of conventional analgesics is ineffective, and the commonly related etiologic factors are fractures, caries, or extensive and deep untreated restorations. When the patient is unable to recognize the tooth responsible for the pain process and the teeth in the region (including those in the opposite arch) also have caries or extensive and deep restorations, diagnosis becomes extremely difficult.
In certain cases, there may be a complete absence of clinical symptoms and the teeth respond normally to thermal tests. There may be a history of trauma, and clinically there may be deep caries, which in most cases results in pulp exposure during removal, absence of percussive and palpatory symptoms, and radiographically the peri-radicular tissues are unaltered.
The emergency treatment in cases of irreversible pulpitis is preferably based on the complete removal of the pulp tissue. If the professional does not have enough time or there is another factor that prevents him or her from proceeding with complete instrumentation of the root canal(s), partial pulpectomy (extirpation of the pulp from the cervical and middle thirds) of all canals (preferably) or at least of the largest canal should be performed.
Endodontic urgency
