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Endodontics · single question

A patient with a periapical abscess on tooth #8 with a labial sinus tract (parulis/fistula). What is the correct diagnosis and treatment?

  1. Reversible pulpitis — pulp capping
  2. Apical abscess with chronic presentation — root canal treatment of tooth #8
  3. Periapical abscess — incision and drainage only
  4. Symptomatic irreversible pulpitis — emergency pulpotomy
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Correct answer: B. Apical abscess with chronic presentation — root canal treatment of tooth #8

  • A. Reversible pulpitis is a mild inflammation; it does not produce sinus tracts or periapical abscess.
  • B. Correct. A chronic apical abscess presents with a draining sinus tract (parulis) and requires root canal treatment of the source tooth to eliminate the infection. The sinus tract typically resolves after successful RCT without separate treatment.
  • C. I&D alone without treating the pulpal source will not resolve a periapical abscess draining through a sinus tract.
  • D. Irreversible pulpitis causes lingering pain; a parulis with sinus tract indicates pulp necrosis, not irreversible pulpitis.

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