{"id":30193,"date":"2026-01-26T08:59:39","date_gmt":"2026-01-26T14:59:39","guid":{"rendered":"https:\/\/www.aae.org\/specialty\/?p=30193"},"modified":"2026-01-19T11:45:16","modified_gmt":"2026-01-19T17:45:16","slug":"case-challenge-6","status":"publish","type":"post","link":"https:\/\/www.aae.org\/specialty\/case-challenge-6\/","title":{"rendered":"Case Challenge"},"content":{"rendered":"\n\n\t

By Dr. Adam Gluskin<\/em><\/p>\n

Case History: <\/strong>A 56 year old male patient was referred for evaluation of tooth #7 and #8. He is asymptomatic, but his general dentist referred him after observing a buccal sinus tract over tooth #7.<\/p>\n

Medical history:<\/strong> Non-contributory, ASA I<\/p>\n

Medications:<\/strong> None<\/p>\n

Allergies: <\/strong>NKDA<\/p>\n

HPI: <\/strong>The patient reports RCT #8 and crowns on #8 and #9 following a bike accident over 20 years ago. The teeth have been asymptomatic ever since, but the patient reports a “bump” in the gums developing on and off over the past year.<\/p>\n

\"\"<\/p>\n

\"\"<\/p>\n

Radiographic evaluation: <\/strong>Periapical radiographs of the maxillary anterior teeth show existing PFM crowns on teeth #8 and #9 with previous root canal therapy of tooth of #8 with a large post. The obturation material is lacking in density in the apical portion of #8. Both #7 and #8 lack a continuous lamina dura and a large periapical radiolucency is present compassing both roots. The severe lack of density within the radiolucency indicates a through-and-through lesion.<\/p>\n

A limited FOV CBCT was exposed revealing an area of low density (14x12x10mm in dimension) encompassing the root apices of #7 and #8. Significant erosion of the buccal and palatal cortical plates is evident. The alveolar bone around #7 and #8 is intact circumferentially.<\/p>\n

Clinical evaluation: <\/strong>Probing depths 2-3mm across all maxillary anterior teeth. None are tender to percussion or palpation. Tooth #7 responded positively to cold testing.<\/p>\n

Tooth #7 has class 1 mobility and #8 has class 2 mobility. A buccal sinus tract is present in the attached gingiva above #7. The #8 and #9 PFM crowns are intact with clinically sealed margins.<\/p>\n

Diagnosis: <\/strong><\/p>\n

Tooth #7 normal pulp with asymptomatic apical periodontitis<\/p>\n

Tooth #8 previously treated with a chronic apical abscess.<\/p>\n\t

Stay tuned! We’ll reveal the actual treatment rendered, and the poll results, in a future edition of\u00a0The Paper Point!<\/em><\/p>\n

Dr. Adam Gluskin is a member of the AAE’s Resident and New Practitioner Committee.<\/em><\/p>\n\n","protected":false},"excerpt":{"rendered":"

By Dr. Adam Gluskin Case History: A 56 year old male patient was referred for evaluation of tooth #7 and #8. 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