Case Challenge
By Mahua Bose Pillai, DDS, MMSc, BDS, MDS
A 16-year-old Hispanic male presented with his mother with the chief complaint of “I have pus coming out of my front tooth”. The patient reported to have started his orthodontic treatment one year ago and within two months of that he started having spontaneous pain on #10, especially when he is in a lying down position. The pain subsided at about the six months period, at which point he noticed a sinus tract apical to #10.
Med Hx: Patient reports no notable medical conditions on review of systems. Patient reports taking no medications and has no known drug allergies.
Clinical Evaluation: A sinus tract is noted on the palatal aspect. The orthodontic bracket on #10 was broken and #10 had no mobility. He had a large fluctuant swelling in the palate 5cm x 4cm and when he pressed on it pus oozed out of the buccal sulcus on #10.
Radiographic Interpretation
#10 has Dens Invaginatus (Oehler’s type I) with a large PARL surrounding #9,10,11. CBCT shows complete loss of palatal cortical plate.
Diagnosis #10 – Pulpal Necrosis with Chronic Apical Abscess.
Stay tuned! We'll reveal the treatment choice used -- plus, more details on the progress of this case and another Challenge Question -- in a future issue of The Paper Point.
In the January 2022 Case Challenge, we posted a challenge question; and now have the answer below!:
| According to Tamse, Fuss and Lustig and Kaplavi’s 1999 evaluation of vertical root fractures in endodontically treated teeth, which of the following was NOT determined to be a predictor of the presence of a VRF? |
|---|
Answer: B.
47 percent of respondents chose this correct answer; way to go!