Treatment of Exacerbated Chronic Apical Periodontitis (Tooth 24) in One Visit

In brief: at KES, an exacerbation of chronic apical periodontitis of tooth 24 (upper first premolar) was treated in a single visit — chemo-mechanical cleaning and a tight obturation of the root canal, followed by a direct composite crown restoration. Single-visit endodontics is as effective as multi-visit treatment: randomized trials report ~88–97% healing at 2 years when the protocol is followed.

Key facts

What is apical periodontitis

Apical periodontitis is inflammation of the tissues around the root apex, usually of bacterial origin: infection reaches the root from a deep carious cavity through an infected or necrotic pulp. The chronic form is symptom-free for a long time and appears on an X-ray as an area of bone rarefaction at the apex (apical destruction). An exacerbation is the shift into an acute, painful phase — a typical sign being pain on biting.

Stage 1. Diagnosis

We took a periapical X-ray (CBCT when indicated), assessed the apical bone destruction and the link between the carious cavity and the canal, and ran percussion and thermal tests. Tooth 24 typically has one or two canals, which we accounted for when planning.

• The X-ray confirmed the inflammatory focus at the apex.
• The carious cavity communicated with the canal system — the infection pathway.
• Pain on biting indicated an exacerbation.

Stage 2. Isolation and endodontic access

The tooth was isolated with a rubber dam for sterility; infected carious tissue was removed and an access cavity to the canal orifices was made. Isolation prevents saliva and bacteria from entering the canal during treatment.

• The rubber dam ensures asepsis and airway protection.
• Removing infected dentin eliminates the bacterial entry point.

Stage 3. Chemo-mechanical cleaning

Canals were negotiated, working length was set with an apex locator, and mechanical and hand instrumentation were performed. Canals were irrigated copiously with sodium hypochlorite (NaOCl) to dissolve necrotic tissue and disinfect, and with EDTA to remove the smear layer. This is the key stage — success depends on how well the canal system is cleaned and disinfected.

• Apex locator + X-ray control the working length.
• NaOCl dissolves organic tissue and kills bacteria; EDTA opens the dentinal tubules.
• Thorough irrigation removes the source of inflammation.

Stage 4. Obturation and crown restoration

The canal was sealed three-dimensionally with gutta-percha and a sealer. In the same visit, the crown was rebuilt with a direct light-cured composite restoration, restoring shape, contact points and chewing function.

• A tight obturation closes the infection’s access to the bone.
• The direct restoration rebuilds the anatomy in one visit.
• If the premolar is substantially broken down, a crown or onlay may later be recommended to protect against fracture.

Single-visit vs multi-visit endodontics: which to choose

Result and prognosis

The inflammation at the apex was eliminated, the canal was hermetically sealed, and the crown was restored — the tooth was preserved without extraction. The prognosis is favourable: systematic reviews and RCTs show that high-quality endodontic treatment heals the periapical tissues in most cases, and single-visit treatment is comparable in success to multi-visit. Bone at the apex recovers gradually, so a follow-up X-ray is scheduled at 6–12 months.

• The tooth was saved in a single visit.
• Bone healing — over several months under follow-up.
• Fracture-risk reduction — a protective restoration (crown/onlay) if needed.

FAQ

Q: How many canals does tooth 24 have?

A: The upper first premolar (tooth 24) most often has one or two root canals, less commonly three. The exact number is determined by X-ray/CBCT and during treatment under a rubber dam.

Q: Can apical periodontitis be treated in one visit?

A: Yes, in most uncomplicated cases. If the canals are patent and there is no active purulent process, cleaning, obturation and restoration are done in a single appointment. RCTs show comparable success to a two-visit approach.

Q: Does periodontitis mean the tooth must be extracted?

A: In most cases the tooth is saved with endodontic treatment. Extraction is considered only with severe root destruction, a vertical fracture, or when the canal cannot be cleaned properly.

Q: Is root canal treatment painful?

A: Treatment is performed under local anaesthesia and is painless. Mild tenderness on biting for the first few days is a normal reaction that gradually subsides.

Q: Is a crown needed after canal treatment?

A: Posterior teeth (premolars and molars) are often reinforced with a crown or a ceramic onlay after endodontics: a non-vital tooth is more brittle, and a protective restoration reduces the fracture risk.

Q: What happens if periodontitis is left untreated?

A: The inflammation destroys the bone around the root, can develop into a cyst or a purulent abscess, and may lead to tooth loss and complications for neighbouring teeth.

Q: How do I know the treatment was successful?

A: Pain and discomfort resolve, and a follow-up X-ray at 6–12 months shows restored bone pattern at the root apex.

Clinic of Aesthetic Dentistry (KES), Kyiv — established in 2000; treatment is performed by top-category doctors. This material is informational; the exact plan is defined after an in-person consultation and diagnostics (X-ray/CBCT).