Example of a Periapical Abscess

Joined
Dec 26, 2023
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80
An example of a periapical abscess: pulp is not vital (does not react to cold), tooth is sensitive to percussion and palpation.

I was wondering why the pain came mainly from above the crown.

The necrotic pulp will be cleaned out. Hope the cause was not a root fracture...which would mean extraction.

Both X-rays from today: the upper by the regular dentist and the lower by the endodontist.

Kraus Jurgen 4762_05-Feb- 2024_0.jpg
feb_5_2024.jpg
 
Joined
Dec 26, 2023
Messages
80
Around the apex. The black shade towards the cervical area is an abfraction.

Diagnosis: necrotic pulp and suspect fracture on tooth #21.

Recommended treatment is endodontic, non-surgical, with an evaluation for fractures and healing prior to obturation.

Questions:

1. How likely is a fracture in a previously untreated maxillary incisor (can't recall any sport/bite trauma other than bruxism)...which means extraction? According to a Taiwanese study in maxillary incisors, only 6% of fractured teeth had not experienced endodontic treatment before.

2. How could I miss the progressing pulpitis...never had pain. Tenderness and pain (2 weeks later) occurred immediately after extraction of #46. Obviously, the weakened immune system played a role.

KrausJurgen87965.pdf (page 2 of 2).jpg
 

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