In two years after RCT, a patient complains of “Pain over the gum” of that tooth and the tooth is tender to percussion, then the treatment of choice is:
**Core Concept**
The question is testing the management of a patient with a possible case of Apical Periodontitis (AP), a common complication of pulp necrosis. AP is characterized by inflammation of the periodontal ligament and surrounding bone, leading to pain and tenderness to percussion.
**Why the Correct Answer is Right**
In the scenario described, the patient is experiencing pain over the gum and tenderness to percussion, indicative of an infected tooth. Two years after the initial root canal treatment (RCT), it is likely that the infection has re-established itself, leading to the development of AP. The treatment of choice in this case is a surgical apicoectomy, which involves the removal of the infected apex of the tooth, along with any infected tissue in the surrounding bone. This procedure is often performed under local anesthesia and can be done in conjunction with a retrograde filling to prevent further infection.
**Why Each Wrong Option is Incorrect**
**Option A:**
This option is incorrect because a simple re-treatment of the root canal (re-RCT) may not be sufficient to address the underlying cause of the pain, which is likely due to the re-establishment of infection at the apex of the tooth.
**Option B:**
This option is incorrect because extraction of the tooth is not the first line of treatment for AP, especially if the tooth is otherwise healthy and the patient desires to retain it.
**Option C:**
This option is incorrect because a dental X-ray would not provide a definitive diagnosis or treatment plan for AP, and may not show the extent of the infection.
**Clinical Pearl / High-Yield Fact**
A key aspect of managing AP is to identify the underlying cause of the infection, which can be due to a variety of factors, including a missed canal during the initial RCT, a fracture of the root, or the presence of a foreign body. A thorough evaluation of the tooth and surrounding tissue is essential to determine the best course of treatment.
**Correct Answer: B. Extraction of the tooth**