The aim of root canal treatment is to clean the space inside a tooth to remove any bacteria or material which is causing a tooth to be painful. It can sometimes be difficult to know how far to go when cleaning. If the tooth is not cleaned all the way to the end then bacteria can remain which can cause ongoing pain/ symptoms long after the root filling is completed. If the root filling is extended beyond the end of a tooth then then this can cause long term irritation and discomfort.
In this case which was referred to us, the patient had constant pain from their upper left central incisor tooth, despite the tooth having what appeared on the x-ray to be a good root filling. The upper right central incisor tooth had a root filling which did not reach the end of the tooth, however, this was symptom free.
A three-dimensional CBCT scan was taken of the area, which shows the root filling in the upper left central incisor has been over-extended through the end of the tooth. This over-extended material was causing an inflammatory response around the end of the tooth resulting in constant low grade discomfort.
To treat this case, the old root filling material had to be removed. Sometimes to do this involves a surgical procedure called an apicectomy, however, in this case we were able to remove all the old root filling material through the original access hole in the tooth. Once the old root filling material was removed, we were able to electronically measure how long the tooth was, and then seal the end of the tooth with a bio-compatible cement (MTA). Once the end of the the tooth was sealed, the remaining space was filled with a conventional root filling material and a white composite filling placed to seal the access hole in the back of the tooth.
When reviewing the patient, she reported the pain from the area had resolved the next day after treatment and she was able to chew again without any discomfort.