Endodontic Approach to a Mandibular Second Molar with Extensive Pulp Calcification and Periapical Abscess

Abstract

Introduction: Endodontic treatment is a means of restoring dental function and preventing tooth loss. Several factors lead to the need for endodontic treatment, including periapical lesions, pulp calcifications, and acute apical abscess (a dental condition involving an inflammatory and infectious process). Presentation of Case: A patient was referred for endodontic treatment of tooth 37, presenting extensive calcification in the pulp chamber and mesial canal, observed on radiographs, in addition to an acute periapical abscess. The examination also revealed bone rarefaction with well-defined borders around two roots, which fuse from the middle third to the apical third, causing external resorption in both and affecting both canals. During the procedure, the distal canal was located and showed substantial drainage, while the mesial canal was difficult to locate, requiring the use of an operating microscope and ultrasound. The treatment was completed without complications, and the canals were sealed with cotton and intermediate restorative material (IRM). After two years of follow-up, the patient was asymptomatic and functional, and after eight months was rehabilitated with a fiberglass post and prosthetic crown, in addition to bone repair of the periapical lesion. Conclusion: Knowledge and technology, together, can make all the difference in more complex cases. In this report, it was possible to confirm the bone healing and regeneration process during the case follow-up using CBCT, which demonstrates the importance of long-term monitoring.