Summary:
-16 years old black female.
•Swelling :Extensive symptomatic nonfluctuant palatal swelling
•Past medical history was negative and oral temperature was 101.6 ºF. •Trauma at a younger age caused the right maxillary central incisor fracture .
•Intermittent palatal swelling and spontaneous drainage has been noted for 1 year.
•Radiographs: Large RL involving the apices of teeth #11,12,13.
•The central incisor did not respond to thermal or electrical pulp tests while the others did.
-Dx: Pulp necrosis with a symptomatic chronic apical periodontitis(Phoenix abscess).
Treatment:
-The maxillary central incisor was opened and suppurative exudate was released.
-WL, Instrumentation, temporized with unmedicated cotton pellet and cavit.
-Antibiotic therapy & Analgesics.
-1 week after the canal was obturated , vertical Incision 1 cm in length Mesial to the right central incisor in the area of root apex and perforation of the cortical bone.
-Drainage of 2 to 3 ml of purulent exudate, the lesion was aspirated and gently irrigated.
-A sterile plastic chuck was inserted through the perforation and the incision was sutured forming a snug collar around the plastic chuck.
-The suture and plastic chuck were removed after 10 days.
-Most highlighted Results:
-No evidence of swelling and the patient had been asymptomatic since the second day after the decompression procedure.
-Progressive osseous repair shown in the postoperative radiographs.
