Report a source of persistent infection
CC: spontaneous pain with intermittent swelling in anterior maxilla.
#7 gross M & D decay
Sinus tract opening between the roots of #6 & 7. Swelling in vestibule + pus drainage upon palpation. Negative to cold & EPT. Sensitivity from both vertical & lateral percussion. PARL 13 x 14.5mm. #6 & 8 normal to sensibility tests & radiographically.
Treatment: 5 instrumentation sessions with > 106 days of CaOH using various [NaOCl]s, and manual dynamic irrigation for 60 seconds at each visit. Persistent sinus tract and pain remained. Canal obturated. Apico completed and root tip analyzed histologically.
- 7 days after surgery, sinus tract healed and symptoms improved.
- Complete bone fill-in of defect by 12 months.
- Lesion was a cyst.
- No bacteria present in the main canal & dentinal tubules at all levels of canal.
- No bacteria colonization along the cyst wall.
- Canal well-prepped, round, no irregularities, & free of debris.
- Large lateral canal with the proximal half free of debris and the distal half clogged with thick biofilm.
Case report of a short-term failure of RCT from a persistent lateral canal infection