Persistent pain in maxillary premolars following root canal treatment with apical transportation: A report of two cases without periapical pathology

Abstract Persistent pain after endodontic treatment is often associated with evidence of periapical pathology. Nonetheless, this case report presents two instances of persistent pain in maxillary premolars post root canal treatment (RCT), without evident periapical radiolucency on imaging. A 35-year-old Asian female experienced dull, aching pain on biting in tooth #25, whereas a 40-year-old Caucasian female reported similar symptoms in tooth #15. Both teeth showed tenderness to percussion but not palpation. Periapical radiographs and cone-beam computed tomography (CBCT) scans revealed completed RCT with apical transportation but no detectable periapical pathology. Thus, both teeth were diagnosed as previously treated with symptomatic apical periodontitis. Non-surgical retreatment successfully addressed untreated canal spaces, resolving symptoms. This report suggested persistent pain following RCT might stem from endodontic reasons, even in the absence of visible apical pathology on CBCT scans, highlighting the importance of thorough canal debridement to resolve symptoms associated with untreated canal spaces in apical transportation. Furthermore, this case report demonstrates that clinicians should make a diagnosis through thorough dental history and other clinical investigations, without relying solely on CBCT for the diagnosis of posttreatment endodontic pain.