Clinical management of root canal treatment in upper second premolar with chronic apical abscess

Abstract

Title: Clinical management of root canal treatment in upper second premolar with chronic apical abscess. Introduction: The purpose of root canal treatment is to remove the affected pulpal tissue along with microorganisms, achieving proper shaping and sealing of the root canals, since pulpal necrosis can generate inflammatory periapical lesions that, if untreated, evolve into chronic apical abscesses. The recommended treatment includes irrigation with sodium hypochlorite, intracanal medication with calcium hydroxide, and antimicrobial therapy with amoxicillin and clavulanic acid. Case presentation: Female patient, 51 years old, who attended the FOUAS clinic reporting swelling, gingival color changes, and tooth loss. During the clinical examination, a sinus tract was observed, followed by a cold sensitivity test on tooth 25, which was negative and showed no response to percussion. The periapical radiograph revealed an apical lesion, diagnosing a chronic apical abscess. Discussion: During antimicrobial therapy, amoxicillin with clavulanic acid 875mg/125mg was administered every 12 hours for 7 days. In contrast, López & Perez⁸ reported the use of metronidazole, 500mg every 8 hours for 10 days in a patient allergic to penicillins. Despite the difference, both treatments were effective, illustrating the importance of individualizing therapy for each case. Conclusions: Pulp necrosis with chronic apical abscess can cause local and systemic complications if not treated in time. Timely diagnosis and appropriate clinical management allowed for controlling the pathology, resolving symptoms, and preserving the affected tooth.