The patient is a 40 years-old female without medical condition, treatment and known allergies that came in emergency for an 8 out of 10 rated pain on the maxilar left canine. She doesn’t smoke, drink alcohol or take drugs, but she has neglected her oral hygiene following a bad experience with her previous dentist.
Clinical examination reveals a distal decay extending subgingivally on the maxillar left canine, confirmed to reach the pulp by the radiological eximination. The pain is spontaneous, radiating, continuous, percussion and palpation tests are negative while the pulp vitality test is painful and persists when the stimulus is stopped.
These different symptoms lead to a diagnosis of irreversible pulpitis.
After carious curretage and dental restoration with glass ionomer ciment, the patient comes back to the dental office with a panoramic radiographic to start a global oral rehabilitation.
Endo-buccal examination reveals a mesial decay on the maxillar right lateral incisor causing gray discoloration, coronal restorations on her 2, 11, 13, 14, 15, 35, 45 and 46 teeth and unworkable dental roots in 3, 18 and 19. The maxillar right second molar is also extruded. All her first premolar are missing due to previous orthodontic treatment.
Radiological examination shows a periapical lesion on her maxillar right and mandibular right premolar.