Endodontics · patient case question
What is the diagnosis?
Patient case: Previously treated #9 with a gutta-percha-traced sinus tract
Scenario: A 35-year-old male with pain on the upper left central incisor. Pain is on BITING. Radiograph shows #9 with ROOT CANAL TREATMENT and an abscess above the tooth that was TRACED USING GUTTA-PERCHA.
Show answer and explanation
Correct answer: B. Chronic apical abscess
- A. Symptomatic apical periodontitis is percussion tenderness WITHOUT a sinus tract or purulent drainage.
- B. Correct. The presence of a SINUS TRACT that can be traced with a gutta-percha point is the defining feature of a CHRONIC APICAL ABSCESS — an inflammatory reaction to pulpal necrosis with GRADUAL onset and INTERMITTENT DRAINAGE through the tract. Because the pus has an exit route, the tooth is typically only mildly symptomatic, though biting discomfort can occur.
- C. Condensing osteitis is a localised RADIOPACITY — a sclerotic bone response to chronic low-grade pulpal inflammation.
- D. An acute apical abscess has RAPID onset with severe pain, marked swelling and often systemic involvement — there is no established drainage tract.
Note: TRACING THE SINUS TRACT is a diagnostic technique worth remembering: thread a size 25-30 gutta-percha cone into the tract and take a periapical. The cone leads to the true source, which is not always the tooth nearest the opening.