Puzzle Case: Why the Fistula?

Terry Pannkuk, DDS, MScD

How do you explain the fistula?

This patient was referred to me after being looked at by his periodontist and restorative dentist. They were confused and so was I by the initial presentation.

Patient: 62 year-old male with atrial fibrillation managed with Digoxin

Chief Complaint: ”Bump on gums”

Dental History: The patient presented with a history of a noticeable lesion at the marginal labial gingival between the maxillary right lateral incisor (#7) and canine (#6). It was first noticed 3 weeks before the consultation visit with the author. Both a periodontist and general dentist had examined the tooth and referred the patient for a third opinion. Level 2/10 pain was described as being intermittent.

Significant Findings: The referring restorative dentist provided a radiograph showing a fistula tracing to the cervical interproximal area most near the canine root surface. Clinical examination revealed slight bleeding upon probing at the mid-labial area with normal circumferential probing depths. There was slight sensitivity upon percussion with Class 1 mobility. Cold thermal testing was within normal limits and the electric pulp test yielded a normal response as it did with all neighboring teeth.

Radiographic and CBCT findings suggested a lingual anomaly on #7.

What is the diagnosis, prognosis and treatment plan?

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1 comment

Commenting Guidelines Please make scholarly cited references or expert opinions suitable for publication. The comments can either be "pro" or "con" with references to the treatment philosophy. We encourage objectivity and detailed demonstration of knowledge/literature.
Jan Skrybant commented 8 years ago.

Without examining the palatal surface of the upper lateral looking at the x-ray, I would suggest internal root resorption with the lateral. Jan

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