If you are interested in an endodontic refresher lecture, come and join me next Thursday at the Pacific Dental Conference (PDC 2019). Two and a half hours lecture filled with pictures and videos demonstrating the initial endodontic treatment.
Patient presents with apparent sinus tract in quadrant 4. According to the patient, the sinus tract had been identified by a hygienist during a hygiene appointment. Subsequently, the endodontic treatment had been initiated in order to resolve the infection. Here is a clinical photo of the sinus tract-like tissue.
The above image shows what appears to be a non-draining sinus tract. If this is indeed the case, it means that there should be a necrotic tooth with a lesion in close proximity to the drainage site and one should be able to express exudate from the site by poking it with a sharp explorer tip. Upon palpation, the tissue felt like a fibrous nodule that can be easily displaced under the non-keratinized tissue and it could not be drained with an explorer. Evaluation of available radiographs confirms lack of apical lesion in this area. Furthermore, the radiographs show significant pulp recession and heavy coronal calcification in all teeth. This could have resulted in false negative pulp vitality test results.
In the absence of periapical radiolucency and pain symptoms, one should not feel pressured to rush into treatment. The diagnosis for the above tooth might have been healthy pulp with normal apical tissues which would have required no treatment. Instead, the overall treatment has resulted in some structural compromise.
Patient presented with #1.3 pulp necrosis and chronic apical abscess. Due to missing #1.2, mesially tilted tooth #1.3 had been restored as #13-#1.4 splinted crowns in the place of #1.2 and #1.3. The clinical picture shows a ceramic interdental papilla which covers the root of tooth #1.3.
The key aspects in treating such a case are as follows: