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. 2014:2014:879562.
doi: 10.1155/2014/879562. Epub 2014 Dec 21.

Rare periodontal ligament drainage for periapical inflammation of an adjacent tooth: a case report and review of the literature

Hongmei Guo  1 , Wei Lu  2 , Qianqian Han  2 , Shubo Li  3 , Pishan Yang  2
Affiliations

Rare periodontal ligament drainage for periapical inflammation of an adjacent tooth: a case report and review of the literature

Hongmei Guo et al. Case Rep Dent. 2014.

Abstract

Aim. To report a case with an unusual drainage route of periapical inflammation exiting through the gingival sulcus of an adjacent vital tooth and review probable factors determining the diversity of the discharge routes of periapical inflammation. Summary. An 18-year-old male patient presented with periodontal abscess of tooth 46, which was found to be caused by a periapical cyst with an acute abscess of tooth 45. During endodontic surgery, a rarely reported drainage route for periapical inflammation via the gingival sulcus of an adjacent vital tooth was observed for the first time. Complete periodontal healing of the deep pocket of tooth 46 and hiding of the periapical cyst of tooth 45 followed after root canal treatment and periapical surgery with Bio-Oss Collagen implantation on tooth 45. The drainage routes of periapical inflammation are multivariate and the diversity of drainage pathways of periapical inflammation is mainly related to factors such as gravity, barriers against inflammation, and the causative tooth itself.

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Figures

Figure 1
Figure 1
Clinical intraoral photographs. (a) Gingival swelling over the buccal region of tooth 30 (see the dark arrow) and healthy gum of tooth 29. (b) A 10-mm pocket in the buccal furcation of tooth 30 at the initial visit. (c) A 4-mm furcal pocket of tooth 30 in three-month follow-up after operation. (d) At 7-month recall, the furcal probing depth of tooth 30 lessened to about 2 mm.
Figure 2
Figure 2
Radiographs. (a) Radiograph at the initial visit showing a large periapical lesion associated with tooth 45, measuring 14 × 15 mm in diameter. (b) A periapical radiograph of tooth 29 and tooth 30 to observe and record the immediate postoperative situation. (c) Radiograph after 3 months showing a decrease in the size of the periapical radiolucency to 13 × 14 mm in diameter and some material implanted seemed to be absorbed. (d) Radiograph after 7 months showing an apparent decrease in the size of the radiolucent area to 4 × 5 mm in diameter.
Figure 3
Figure 3
Intraoperative photographs. (a) Osseous destruction region did not involve the root apex of tooth 30. (b) Osseous destruction region around the root apex of tooth 29 penetrated through periodontal ligament of the mesial root and involved the furcation area of tooth 30. (c) Osseous destruction region was filled with Bio-Oss Collagen.
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