Endodontic Approaches and Clinical Management of Teeth with Acute Apical Abscess: Two Case Reports

Aim: Acute apical abscess usually develops as a result of a bacterial infection originating from

a necrotic pulp and spreading into the periapical tissues. This case report presents the

endodontic treatment approaches and clinical management of two acute apical abscess cases

located in different anatomical regions. Case Description: Case 1: A 37-year-old male patient

presented to the clinic with complaints of intraoral and extraoral swelling. Radiographic

examination revealed root canal treatment and metal posts in the maxillary left central and

lateral incisors, accompanied by periapical radiolucent lesions around the affected teeth. During

the first appointment, the metal posts were removed using an ultrasonic device and tips

(Woodpecker®, Guilin Woodpecker Medical, Guilin, China). The root canal preparation was

completed with NIC O File® and NIC X File® systems (NIC Endo, Changzhou, China), and

drainage was established through the buccal region. Calcium hydroxide intracanal medication

(UltraCal™ XS, Ultradent, South Jordan, USA) was placed into the root canals for two weeks.

Once the teeth became asymptomatic, the root canals were obturated using the single-cone

technique with gutta-percha and Bioserra® sealer (Bioserra Dental, Ankara, Türkiye). In the

following session, glass fiber posts were placed, and the access cavities were restored with resin

composite. Case 2: A 39-year-old female patient presented to the clinic with complaints of

severe pain, marked percussion sensitivity, and extraoral swelling in the left mandibular region.

Radiographic examination revealed that the mandibular left second molar had previously

undergone root canal treatment and exhibited a periapical radiolucency in the apical area.

Nonsurgical endodontic retreatment was indicated for the involved tooth. Root canal

preparation was performed using the NIC O File® and Scope W Gold® rotary systems (Scope

RS, Yozgat, Türkiye) following the manufacturer’s instructions. Due to the presence of

systemic symptoms, the patient was prescribed amoxicillin–clavulanic acid (Augmentin® 1000

mg) and ibuprofen (Brufen® 600 mg). After cessation of purulent drainage, calcium hydroxide

intracanal medication was placed for disinfection. Once the tooth became asymptomatic, root

canal obturation was completed with gutta-percha and sealer, and the access cavity was restored

with resin composite. Results: At the 12-month follow-up, both cases were asymptomatic, the

treated teeth remained functional, and radiographic examination revealed evident periapical

healing. Conclusion: In cases of acute apical abscess, endodontic treatment, surgical drainage,

and antibiotic therapy should be considered collectively. Early diagnosis and a combined

therapeutic approach are essential for preventing the spread of infection and promoting faster

healing.