A 40 year old female patient came first time to my clinic with severe pain and she was uncomfortable with her dislodged restoration between E and 16.The restoration removed under antibiotic coverage,a little piece of tooth structure came out along with the dislodged filling, IOPA taken to check the status of the tooth .The x ray revealed impacted premolar in the same region.Patient was adviced OPG and prescribed antibiotic and anti-inflammatory drugs..OPG was not clear and revealed cystic formation around premolar, after a few days patient came with
pain and swelling in the same region .On intra oral examination Gingival sinus in 16 region appeared and pain has reduced.IOPA taken again with different angle and it revealed the apex of premolar which was actually responsible for the Gingival sinus.
Patient was advised surgical extraction of the tooth,removal of cystic lining if needed, RCT or extraction of 16
- 55-Resorbed roots,carious distally
- 16-mesially deep carious,approximating pulp....adv RCT but since it is associated with gingival sinus prognosis will be poor.
- 14/15?-missing congenitally
- 14/15-impacted,apex between 55 and 16-upside down ,crown might need sinus lift during surgery due to its location or for enucleation of cyst
INVESTIGATION-
Complete Haemogram, BT ,CT, PTT, Blood sugar, repeat OPG, CBCT of maxilla, Histopathological specimen to be sent to the lab after surgery to prevent the spread and Ameloblastoma in relation to the same teeth.
check Vital signs before surgery.
