Page 12 - The Beauty and Sorrow in Endodontics-Chapter 3

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S Age/Gender: 30 M
CC: “Was referred by my periodontist for evaluation before the surgery”
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HCC: Patient reported intermittent gingival swelling between teeth 21 and 22 for a
year with suppuration. He reported no history of pain, but the teeth have been

getting looser over time and he’s worried he will lose the teeth if they are not
treated in time.

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O Rad: 11, 22 No caries; Clearly discernable root canals
# 21M vertical bone loss (Fig 31A)
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I/O: Sinus tract on buccal gingiva between 21 and 22 (Fig 31B)
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# 11, 22 M1, PD 7 mm, EPT (+)
# 21 M2 , Palatal PD 10mm, EPT (+)
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A Dx: 21
Pulpal: Normal
Periapical: Normal

Etiology: Periodontal; no endodontic involvement
P Discussed proposed treatment plan with the patient. Informed consent obtained to

proceed.

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1) 21 Root planning with open flap surgery +/- bone graft (with periodontist)
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The periodontist reported a connection from 21 palatal defect that wrapped
around the distal surface to the buccal sinus tract opening (Fig 31C). This
confirmed the diagnosis that the periodontal abscess and sinus tract originated

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from the deep periodontal pockets of 21.
2) 21 Cavity test without anaesthetics to confirm continued pulpal vitality in the
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future

3) Follow-up

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