If there is fracture line present on pa radiograph, the tooth certainly is hopeless. If the patient was asymptomatic and refused extraction, do,nt do anything. On the other hand, if patient was hurt and refused extraction, just prescribe antibiotics and pain killer. The bottom line is, rct is futile and may introduce microorganisms to periapical tissue, w which may cause more infection.
I'm really sorry that my reply is too late. Thank you for giving me advice.But I forgot to write in my message.My patient went to another dentist before she came to see me 2 months ago.He opened pulp chamber and placed dressing for that tooth.He told my patient that multiple visits need for RCT.But she didn't go and see him.
After 2 months, she came to see me and at that time, she told me that she put a small cotton into that tooth when she eat.After removing that cotton,I saw some bleeding near pulp chamber and she said she had no feeling for that tooth but actually she came to me to receive a filling treatment. and at first, I advised her to take intra-oral periapical view.In that X-ray, I saw one fracture line near apical third. Firstly, I told her to receive extraction because she had to go to other country and she had 1 week to stay here.But she refused my advice.and then she asked me is there any treatment except extraction.So,I told her another treatment,RCT. I told her that I was not sure to cure it completely, but she accepted it.And then I gave her root canal treatment.During that treatment,she had no pain and no swelling.But 3days after obturating that tooth,she suffered swelling and slightly pain,I want to know what cause it is.
I requested my senior dentist about that case.
He precribed Lincomycin and Metronidazole 200mg for 10 days.
But 2days after taking that medicine,swelling is near completely reduced and her face changed to normal position and she didin't feel pain anymore.That was amazing.
Could you tell me what cause it is?
I really want to know that.
Please give your expert opinion and management .
Firstly, root fracture commonly occurs in upper half,instead of apical third. You may need to re-evaluate x-ray again.post obturation pain and swelling are commonly associated with acute periapical infection,systemic administration of appropriate antibiotics generally can clear up acute infection, there is no magic at all. As long as there is no fracture and the canal is optimally obturated, the prognosis is good.clindamycin is very effective for bone infection.metronidazole is effective for periodontal pathogens. Clindamycin +metronidazole is a common prescription for jaw bone infection, including post lower 3 molar extraction medication.