Example of a Periapical Abscess

[Brause]

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.

 

[Dr M]

If you mean above the crown? Are you referring to the gingiva?

 

[Brause]

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.