Endodontic Management of a Mandibular Second Molar Acute Apical Abscess: A Case Report

Abstract

Acute apical abscess is an inflammatory condition of periradicular tissues that usually develops secondary to microbial infection of the root canal system. It may present with pain, tenderness, suppuration and swelling, and, in some cases, the infection may extend beyond the intraoral region. This case report describes the endodontic management of a 26-year-old female patient with severe localised pain and progressive swelling in the left buccal region associated with the mandibular left second molar. Clinical examination showed tenderness to percussion and no response to electric and thermal pulp vitality tests. Periodontal probing depths were within normal limits, and radiographic examination revealed a well-defined periapical radiolucency associated with the mesial and distal roots. A diagnosis of pulpal necrosis with acute apical abscess was made. Non-surgical root canal treatment was initiated under local anaesthesia and rubber dam isolation. Working length was determined electronically and confirmed radiographically. Chemo-mechanical preparation was performed using 2.5% sodium hypochlorite and saline irrigation, followed by placement of calcium hydroxide as an intracanal medicament. Because of extra-oral involvement, amoxicillin was prescribed. At review, swelling and spontaneous pain had resolved. The canals were subsequently irrigated, dried and obturated with gutta-percha and bioceramic sealer using a continuous wave condensation technique. Follow-up evaluations at 3 and 18 months showed that the patient remained asymptomatic. Radiographic review demonstrated progressive healing and resolution of the previously observed periapical radiolucency. This case supports the role of appropriate non-surgical endodontic treatment in managing acute apical abscess when the tooth is restorable and monitored.