Partially necrotic cases can be very difficult to diagnose, even for many endodontists. This was the case on tooth No. 2, in which the patient had a sinus tract on the palatal that could not be traced. Tooth No. 2 did not have any prior dental work. Teeth No. 2 and 3 responded within normal limits to thermal pulp testing. However, upon percussion, tooth No. 2 was slightly more percussion-sensitive than tooth No. 3. Also, tooth No. 2 had a microscopic crack that contributed to this issue.
|Figure 1. The pre-op photo shows the sinus tract on the lingual aspect. It wasn’t traceable with gutta percha.||Figure 2. This pre-op radiograph shows tooth No. 2 with no restorations in place and tooth No. 3 with a posterior composite.|
|Figure 3. The radiograph shows endodontic treatment initiated with Ultradent’s UltraCal calcium hydroxide placed.||Figure 4. The radiograph shows endodontic treatment completed on tooth No. 2.|
|Figure 5. This post-op photo shows the resolution of the lingual sinus tract.|
Based on my previous experience with these cases, I decided to do endodontic treatment on tooth No. 2. I told the patient that if the area did not heal, I would refer her to an oral surgeon for a biopsy. The tooth was opened and the pulp was partially necrotic. The palatal root was completely necrotic. Calcium hydroxide was placed, and the patient returned in 2 weeks to complete endodontic treatment. Proper endodontic therapy caused the sinus tract to resolve.
Rico D. Short, DMD, attended the Medical College of Georgia (MCG) School of Dentistry to attain a Doctor of Dental Medicine degree in 1999. In 2002, he earned his postdoctorate degree in endodontics from Nova Southeastern University and became a Diplomate of the American Board of Endodontics in 2009. Dr. Short is an expert consultant in endodontics to the Georgia Board of Dentistry and assistant clinical professor at the Dental College of Georgia in Augusta. Dr. Short also has published articles in several magazines and peer-reviewed journals including Dentistry Today, Inside Dentistry, Rolling Out Magazine, Upscale Magazine, and the Journal of Endodontics. He has lectured throughout the United States and the Caribbean. Dr. Short is endorsed by the American Association of Endodontists speakers bureau, and his private practice, Apex Endodontics PC, is located in Smryna, Ga. Dr. Short also has authored a book, Getting to the Root of Your Problem: 365 Days of Inspirational Thinking.