Authors
1
Department of Endodontics, Faculty of Dentistry, King Abdualziz University, Jeddah, Saudi Arabia
2
Department of Oral Biology, Faculty of Dentistry, King Abdualziz University, Jeddah, Saudi Arabia
3
Department of Operative dentistry, Faculty of Dentistry, King Abdualziz University, Jeddah, Saudi Arabia
4
Department of Oral Diagnostic Science, Faculty of Dentistry, King Abdualziz University, Jeddah, Saudi Arabia
Abstract
Flare-up following endodontic treatment is an undesirable complication. In this case report, the patient presented with severe pain and swelling in the mandibular left quadrant, related to teeth # 35 and # 36. Clinical evaluation revealed an intraoral palpable bluish swelling. Past dental history showed that tooth # 36 was endodontically treated four years ago. The tooth was asymptomatic until the lingual cusp was fractured. A general practitioner replaced the coronal restoration, prepared the tooth, and took final impression. Immediately after, the patient developed symptoms and received antibiotic and analgesic therapy for three weeks.
Following comprehensive clinical assessment, tooth # 35 was excluded as a culprit, and tooth # 36 remained under investigation. Clinical and radiographic examination of tooth # 36 showed a less than-optimal root canal filling, furcation involvement, narrow zone of attached gingiva, and history of replacement of the coronal filling with post and core, which might have had an impact on the ecology of the tooth; all were suggestive of endodontic disease. On the other hand, perplexing signs such as lack of tenderness to percussion and continuity of the lamina dura, suggested otherwise.
The case was diagnosed as a previous root canal treatment with normal periapical tissue, and accordingly, endodontic retreatment was instigated. In addition, exploratory surgery was performed and blue pieces of elastomeric impression material were found, which might have been the cause of all the signs and symptoms. In this case, foreign body reaction is a probable diagnosis. The purpose of this report is to forewarn dentists of the risks associated with impression material in case of periodontal disease and to emphasize the importance of prioritizing the patient data to avoid the pitfalls of misdiagnosis and unnecessary treatment.
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