Asih Rahaju, Fikri Insani Rohadi

ENDODONTIC MANAGEMENT OF IRREVERSIBLE PULPITIS IN MANDIBULAR SECOND MOLAR: CASE REPORT

Introduction

Endodontic management of irreversible pulpitis in mandibular second molar: case report. Discover effective endodontic management for irreversible pulpitis in a mandibular second molar with complex anatomy. Case report details successful root canal therapy.

Abstract

Irreversible pulpitis is a permanent inflammatory condition of the dental pulp, generally caused by bacterial invasion from deep caries, and is characterized by spontaneous pain that cannot be reversed even after the removal of etiologic factors. Permanent mandibular molars, such as tooth 37, often present complex root canal anatomies, including C-shaped canals, two distal canals, or a middle mesial canal, which may directly affect the success of endodontic treatment. This case report aims to describe the management of multiple root canal treatments in a permanent mandibular molar diagnosed with irreversible pulpitis due to deep caries, and to evaluate clinical and radiographic outcomes after therapy. A 35-year-old male patient presented to the Dental Hospital of Jenderal Achmad Yani University with a chief complaint of spontaneous pain in tooth 37 that interfered with daily activities. Clinical examination revealed extensive coronal destruction, a positive painful response to pulp vitality testing, and radiographic findings of deep caries approximating the pulp with periodontal ligament widening but without signs of abscess. A diagnosis of irreversible pulpitis was established, and root canal therapy was performed, including rewalling restoration, biomechanical preparation with hand K-files up to master apical file #25, irrigation with 2.5% sodium hypochlorite and saline, followed by obturation using the lateral condensation technique with resin-based sealer. Final restoration was achieved with an indirect composite to restore masticatory function and prevent reinfection. At follow-up, the patient reported no symptoms, with normal clinical and radiographic findings, indicating successful treatment and functional tooth preservation. In conclusion, irreversible pulpitis in mandibular molars with complex canal morphology can be effectively managed with conventional root canal therapy, where accurate preparation and proper coronal restoration play a more significant role in long-term success than the obturation technique employed. DOI : 10.54052/jhds.v5n2.p227-236

Review

This case report, titled "ENDODONTIC MANAGEMENT OF IRREVERSIBLE PULPITIS IN MANDIBULAR SECOND MOLAR," effectively details the clinical management of a common yet challenging dental condition. The abstract clearly outlines the presentation of a 35-year-old male with irreversible pulpitis in tooth 37, a scenario frequently encountered in general dental practice. The authors provide a concise and logical flow from diagnosis, including clinical and radiographic findings, through the comprehensive root canal therapy, to the final restoration and successful follow-up. The clear documentation of symptom resolution and functional tooth preservation underscores the practical relevance of the treatment described. While the abstract highlights the potential for complex root canal anatomies in mandibular molars and concludes that complex morphology *can* be effectively managed, it does not explicitly detail the specific canal complexity encountered in *this particular case*, beyond mentioning "multiple root canal treatments." This omission, though minor for an abstract, could be clarified in the full paper to fully substantiate the claim of managing "complex canal morphology." The technical steps, including biomechanical preparation with K-files up to MAF #25, 2.5% NaOCl irrigation, lateral condensation with resin-based sealer, and an indirect composite restoration, represent standard and accepted clinical protocols. However, the concluding remark that "accurate preparation and proper coronal restoration play a more significant role in long-term success than the obturation technique employed" is a strong statement derived from a single case; while intuitively appealing and supported by broader literature, it warrants cautious interpretation as a definitive conclusion from a single case report. Overall, this case report serves as a valuable reinforcement of conventional endodontic principles for managing irreversible pulpitis in a challenging posterior tooth. It successfully demonstrates that a meticulous approach, encompassing thorough diagnosis, comprehensive root canal preparation and cleaning, and appropriate coronal sealing, leads to predictable positive outcomes. The paper contributes to the clinical literature by showcasing successful functional tooth preservation in a common clinical scenario. Future research could build upon this by presenting cases with *explicitly* detailed complex anatomies and discussing how specific challenges were overcome, further substantiating the authors' concluding statement on the relative importance of preparation/restoration over obturation technique in a more robust study design.

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