A 23-year-oldmale patient with good general health was referred for the Department of Endodonticsin the local institute. His chief complaint was pain associated with biting andtemperature changes in the maxillary right central incisor. On examination,there was a Class III composite restoration in the mesiolabial aspect andsuperficial crack in the labial wall of the crown in a cervicoincisaldirection. Cold test caused exacerbation of pain that was sustained for severalminutes. The gingival tissues were inflamed and there was painful responsive tovertical percussion. However, the A radiographic examination revealed normalfeatures in the periapical region but the lamina dura was slightly widened.
Irreversible pulp inflammation was diagnosed. The treatmentplanning involved RCT with management of the cracked crown using simvastatin. Detailsof the case and the treatment planning were discussed with the patient.
Hesigned an informing consent for using simvastatin and acknowledge that heunderstood that this material will be used as intra-canal medication and it wasnot previously used for this purpose. The patient agreed and permitted the publicationthe case report.The patient wasgiven a local anesthetic infiltration using 2% lidocaine and 1:100,000epinephrine (Lidocaine, Alex Pharma, Egypt) and tooth was isolated with rubberdam.
Endodontic access was performed following the conventional guidelines. A superficial crack was observed from the accesspreparation in labial wall that extended toward the incisal edge (Figure 2).The workinglength was established 1 mm from the radiographic apex, and the root canal wasprepared using Revo-S endodontic files (MICRO-MEGA® SA-Frane)and 2.5% sodium hypochlorite (NaOCl) for irrigation. Final irrigation was performedwith 17% ethylene diamine tetra acetic acid (EDTA) (META Biomed Co, Korea) andthe canal was then dried with absorbent paper points.
Calcium hydroxidemedicament (META Biomed. Co, Korea) was placed into the root canal and the coronalcavity was provisionally sealed. The patient wasrecalled after 1 week for removal of calcium hydroxide medication. He showedpain with filing at the coronal third of the labial wall.
The labial wall of canalpreparation appeared dark, rough and sensitive although many trials forcleaning and shaping were done. Simvastatin was mixed with distilled water andapplied inside the canal on the master cone and was kept in the canal for 3months. Occlusal reduction was performed forelimination of occlusal contacts to avoid any overload or possibility of splittingthe cracked tooth.
The patient didnot report painful symptom during rest treatment. After 3 months, the gingivaappeared normal and radiograph showed normal periodontal ligaments with normallamina dura. Root canal obturation was performed by lateral condensationtechnique using gutta-percha and and AH-26 sealer (Dentsply, DeTrey, GmbH,Konstanz, Germany). Coronal sealing was immediately performed with arestorative glass ionomer filling (Figure 3). Thepatient was recalled after one day, one weeks and 6 months.
The signs andsymptoms had completely disappeared after one week of treatment.