A 56 years old Saudi female patient came to the ER complaining: "I have pain in my lower right teeth whenever I eat or drink (pointing to #47 and #48)”. Medical hx was reviewed, the patient reported the following conditions: - DM Type I - Controlled with insulin injections. - Increased liver enzymes due to hx. of Jauidance 10 years ago, the patient mentioned that she's following-up the condition, and according to her its not related to a viral infection. - Back Friction. Glucose Level was measured: Reading (1): 337/110 Reading (2): 322/119 Extra-oral examination: All within normal. Intra-oral examination showed: - #47 showed caries, necrotic pulp with symptomatic apical periodontitis. - #48 showed caries, irreversible pulpitis with symptomatic apical periodontitis. Radiographic Ex: BW radiograph showed: - #47 showed (M) tilted tooth with badly carious tooth (OD). - #48 showed deep (D) caries. PA radiograph showed: - #47 have widening of PDL. Pulp vitality test: - #47 have necrotic pulp with symptomatic apical periodontitis. - #48 have irreversible pulpitis with symptomatic apical periodontitis. The patient reported that she didn't take her insulin injection this morning. The patient was re-scheduled for management of teeth #47 and #48. • What do you think the treatment plan should be?

Pt came with sever pain from tooth #45, medically fit . Clinical and Radiographic Findings: OD composite restoration with recurrent caries Cold test —> Irreversable pulpitis Percussion —> Abnoraml response, acute apical periodontitis RCT was planned.

50 y/o male pt he is medically fit complain of “I want to extract my remaining tooth in the lower left area and I want to do implant” OPG x-ray showed apical radiolucency related to remaining root #35 What is the diagnosis ? How will you manage ? can we do immediate implant ?

10 years female patient not aware of any medical problem. Her chief complaint “i feel severe pain on my lower right tooth for 1 week”. History of chief complaint: 1 week ago. Clinical finding: large mesial caries. Radiographic findings: large mesial caries with periapical infection. Patient takes ibuprofen. What is your diagnosis and management?

Chief complaint of the patient: I have severe spontaneous pain on my tooth .. pointed to #48 History of chief complaint: It started last week He took ibuprofen to control the pain Medical history: not aware of any medical problems Diagnosis: symptomatic irreversible pulpitis with symptomatic apical periodontitis Treatment plan: RCT Tx done Local anesthetic, Rubber dam, pulpectomy, cleaning & shaping using protaper universal, then in the next visit obturation by warm vertical technique. 2 mesial canals were joined. Your comment is valuable for me, Thank you all.