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Punch in the face - Courtesy ROOTS

The patient was involved in a fight when he was 18 years of age, and sustained a trauma on his upper anterior teeth by a punch in his face. 21 was luxated, and eventually extracted. Cold test and EPT: WNL on 13, 12 and 21.

RCT on 11 was done by me 2 years ago. I looked back in the patient file, and noticed that I had a hard time to obtain a dry canal at that time. I had to postpone obturation twice, due to a weeping canal, and finally I was able to finish treatment with an apical plug of MTA, gutta-percha and a buildup of composite (so no post)

After going over the whole history and the postive vitality tests on 12, I had to conclude that it had to be a persisting apical pariodontitis of 11, draining through the PDL of 12. Which turned out to be correct!! I raised a flap, did an apexresection on 11, and 2 months later the pocket and sinus tract had disappeared, and 12 tested still vital. I did a biopsy, and the histogical examination indicated the presence of a cyst.

6 months follow-up showed healing. Patient is free of symptoms. I include the whole case. - Marga

Beauty, brains, and more endodontic ability that 99.999999% of the world population. Absolutely excellent case and documentation for presentation purposes, all the time singing your praises and heaping credit upon you. - Gary

Beautiful as usual and very good teaching in how important diagnostic is. I think a lot would have jumped in and treated 12 even though positive to sens. test. - Harald Prestegaard

On the x-rays is the white line a tracing from the S. Tract ? Very nice case, good to have it stored somewhere as a diagnostic possibility, - Thomas