A Patient Presenting With Vague Pain

فارسی

• The patient presented with vague pain in the mesial region of the upper left first molar (tooth 6). The pain was described mostly as a vague interdental pain.

  On examination, the contact was closed and the pain was not reproduced by passing dental floss; therefore, active food impaction or an open contact was not strongly considered as the main cause.

• On radiography, an extensive amalgam restoration was seen whose contour was unfavorable in the mesial region and next to the bone.

  The shape of the restoration had effectively disrupted the natural space of the interproximal region, and given its position, the possibility of violation of the biologic width was raised.

  In addition, slight resorption of the bony crest was seen in the same region, which can be a sign of the periodontal tissue's response to this very violation.

• In such conditions, the patient's pain is not necessarily due to caries or an endodontic problem;

  rather, the change in the restoration's contour and its excessive proximity to the bone can cause chronic inflammation and vague discomfort in the region.

• The logical treatment in this situation is complete removal of the amalgam and careful assessment of the remaining tooth tissue.

  Next, the status of the biologic width must be assessed. If violation of the BW is confirmed, to create an adequate biologic distance crown lengthening surgery will be needed.

  After correcting the periodontal conditions and creating adequate space, final reconstruction of the tooth with a correctly designed contour and ultimately prosthetic treatment (abutment and crown) can provide a more acceptable prognosis.

• This case is a simple reminder that in proximal restorations, merely closing the contact is not enough;

  a correct contour and respect for the biologic width play just as great a role in the health of the tissues around the tooth.

The content of this page is intended for the educational use of dentists and dental students.