Management of a mid-treatment flare-up

The primary aim of endodontic treatment is biomechanical preparation of the root canal and to hermetically seal it with no discomfort to the patient, providing conditions for the periradicular tissues to heal. The occurrence of interappointment pain and swelling is not a rare event even when endodontic treatment has followed acceptable standards. A flare-up can be defined as pain and/or swelling of the facial soft tissues and the oral mucosa in the area of the endodontically treated tooth that occur within a few hours or a few days following the root canal treatment, when clinical symptoms are strongly expressed and the patient visits a health care institution sooner than scheduled. Flare-up can manifests as pain of varying intensity which occurs following an access opening without instrumentation. Although the reasons for such exacerbations are not always clear, there are a number of hypotheses for its occurance: alteration of the local adaptation syndrome, changes in periapical tissue pressure, microbial factors, effects of chemical mediators, changes in cyclic nucleotides, immunological phenomena and various psychological factors. This case report describes the management of Mid-treatment flare-up in the Permanent Maxillary anterior teeth.